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Park SB, Kwon KY, Lee JY, Im K, Sunwoo JS, Lee KB, Roh H, Ahn MY, Park S, Kim SJ, Oh JS, Kim JS. Lack of association between dopamine transporter loss and non-motor symptoms in patients with Parkinson’s disease: a detailed PET analysis of 12 striatal subregions. Neurol Sci 2018; 40:311-317. [DOI: 10.1007/s10072-018-3632-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
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“Pure apathy” and cognitive dysfunctions in Parkinson’s disease: A meta-analytic study. Neurosci Biobehav Rev 2018; 94:1-10. [DOI: 10.1016/j.neubiorev.2018.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/31/2018] [Accepted: 08/06/2018] [Indexed: 11/21/2022]
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Interaction Between Neuropsychiatric Symptoms and Cognitive Performance in Parkinson's Disease: What Do Clinical and Neuroimaging Studies Tell Us? Curr Neurol Neurosci Rep 2018; 18:91. [PMID: 30324260 DOI: 10.1007/s11910-018-0907-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW Parkinson's disease was studied for a long time from the prism of a motor impairment. Recent advances have outlined the importance of cognitive and neuropsychiatric symptoms (NPS) in the PD equation. This review concentrates on the present possibilities of using neuroimaging techniques in order to quantify the cognitive performance and NPS in PD patients. RECENT FINDINGS Mild cognitive impairment as well as many NPS have been acknowledged as important criteria for assessing the quality of life in patients with Parkinson's disease and have been shown as potential factors in predicting further evolution of PD from a clinical perspective. Some NPS strongly influence cognition (depression, REM sleep behavior disorder), while others are less specifically associated with it (impulse control disorders). Neuroimaging techniques reported specific structural, functional, and metabolic brain changes that might be specific for each NPS type. Recent neuroimaging advances report a strong interrelation between NPS and cognitive performance in PD. A special place for consideration is given to REM sleep behavior disorder, depression, and hallucinations. Nevertheless, some studies report distinct results, outlining that the neuroimaging acquisition and analysis techniques still have limitations and also likely represent the complexity of the manifestation of NPS in PD.
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Lee HR, Park JH, Han SW, Baik JS. Cognition, Olfaction and Uric Acid in Early de novo Parkinson's Disease. J Mov Disord 2018; 11:139-144. [PMID: 30304927 PMCID: PMC6182300 DOI: 10.14802/jmd.18037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/11/2018] [Indexed: 12/11/2022] Open
Abstract
Objective
Cognitive impairment is one of the nonmotor symptoms in Parkinson’s disease (PD), and olfactory dysfunction is used as a marker to detect premotor stages of PD. Serum uric acid (sUA) levels have been found to be a risk factor for PD. Our objective in this study was to examine whether sUA levels are associated with cognitive changes and olfactory dysfunction in early de novo PD patients. Methods
The study participants included 196 de novo PD patients. We assessed cognitive function by the Korean versions of the Mini-Mental State Examination and the Montreal Cognitive Assessment and assessed olfactory function by the Korean version of the Sniffin’ Sticks test. Results
The mean sUA level was 4.7 mg/dL and was significantly lower in women than in men. Cognitive scores were lower in women, suggesting that sUA levels were related to cognitive function. The olfactory functions were not related to sUA level but were clearly associated with cognitive scores. Olfactory threshold, odor discrimination, and odor identification were all significantly related to cognitive scores. Conclusion
We conclude that lower sUA levels were associated with cognitive impairment, not olfactory dysfunction, in de novo PD patients. This finding suggests that UA is neuroprotective as an antioxidant in the cognitive function of PD patients.
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Affiliation(s)
- Hwa Reung Lee
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.,Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Hyun Park
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sang Won Han
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jong Sam Baik
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Comparative cognitive and neuropsychiatric profiles between Parkinson’s disease, multiple system atrophy and progressive supranuclear palsy. J Neurol 2018; 265:2602-2613. [DOI: 10.1007/s00415-018-9038-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/25/2018] [Accepted: 08/27/2018] [Indexed: 01/18/2023]
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56
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Apathy in individuals with Parkinson's disease associated with mild cognitive impairment. A neuropsychological investigation. Neuropsychologia 2018; 118:4-11. [DOI: 10.1016/j.neuropsychologia.2018.05.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 12/31/2022]
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Le Heron C, Apps MAJ, Husain M. The anatomy of apathy: A neurocognitive framework for amotivated behaviour. Neuropsychologia 2018; 118:54-67. [PMID: 28689673 PMCID: PMC6200857 DOI: 10.1016/j.neuropsychologia.2017.07.003] [Citation(s) in RCA: 202] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/19/2017] [Accepted: 07/06/2017] [Indexed: 12/23/2022]
Abstract
Apathy is a debilitating syndrome associated with many neurological disorders, including several common neurodegenerative diseases such as Parkinson's disease and Alzheimer's disease, and focal lesion syndromes such as stroke. Here, we review neuroimaging studies to identify anatomical correlates of apathy, across brain disorders. Our analysis reveals that apathy is strongly associated with disruption particularly of dorsal anterior cingulate cortex (dACC), ventral striatum (VS) and connected brain regions. Remarkably, these changes are consistent across clinical disorders and imaging modalities. Review of the neuroimaging findings allows us to develop a neurocognitive framework to consider potential mechanisms underlying apathy. According to this perspective, an interconnected group of brain regions - with dACC and VS at its core - plays a crucial role in normal motivated behaviour. Specifically we argue that motivated behaviour requires a willingness to work, to keep working, and to learn what is worth working for. We propose that deficits in any one or more of these processes can lead to the clinical syndrome of apathy, and outline specific approaches to test this hypothesis. A richer neurobiological understanding of the mechanisms underlying apathy should ultimately facilitate development of effective therapies for this disabling condition.
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Affiliation(s)
- C Le Heron
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
| | - M A J Apps
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - M Husain
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
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Perri R, Carlesimo GA, Costa A. The contribution of neuropsychological and neuroimaging research to the definition of the neurocognitive correlates of apathy. Neuropsychologia 2018; 118:1-3. [PMID: 30125588 DOI: 10.1016/j.neuropsychologia.2018.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Roberta Perri
- Department of Clinical and Behavioral Neurology, Santa Lucia Foundation, Rome, Italy.
| | - Giovanni Augusto Carlesimo
- Department of Clinical and Behavioral Neurology, Santa Lucia Foundation, Rome, Italy; Department of Systems Medicine, Tor Vergata University, Rome, Italy.
| | - Alberto Costa
- Department of Clinical and Behavioral Neurology, Santa Lucia Foundation, Rome, Italy; Department of Psychology, Niccolò Cusano University, Rome, Italy.
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Cerasa A. Re-examining the Parkinsonian Personality hypothesis: A systematic review. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2018.03.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Terashi H, Ueta Y, Kato H, Mitoma H, Aizawa H. Characteristics of apathy in treatment-naïve patients with Parkinson's disease. Int J Neurosci 2018; 129:16-21. [PMID: 30035696 DOI: 10.1080/00207454.2018.1503184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Although apathy is a common psychiatric symptom of Parkinson's disease (PD), there are many unknown aspects of its pathology. This study aimed to investigate the characteristics of apathy in treatment-naïve patients with early-stage PD. METHODS Fifty treatment-naïve patients with early-stage PD were divided into 1 of 2 groups-apathetic or non-apathetic-based on Starkstein Apathy Scale (AS) scores. Cognitive function, depressive symptoms, olfactory function, and motor severity were compared between the two groups using validated assessment scales. Multiple linear regression was performed to assess the association between AS scores and clinical parameters. RESULTS Apathy (AS score ≥16) was observed in 13 (26%) patients. Assessment scale scores (Beck Depression Inventory-Second Edition [p < .004]; modified Hoehn & Yahr stage [p = .039]; Unified Parkinson's Disease Rating Scale part III [p < .001]) were significantly higher in apathetic patients than in non-apathetic patients. Significant association between these scale scores and AS score was also evident (all p ≤ .001). There were no significant differences in the test scores derived from several other validated scales. CONCLUSION Apathy was observed in 26% of treatment-naïve patients with early-stage PD. Significant association between apathy and motor severity was found, suggesting that dysfunction of the dopaminergic pathway is involved in the pathology of apathy.
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Affiliation(s)
- Hiroo Terashi
- a Department of Neurology , Tokyo Medical University , Shinjuku-ku , Tokyo , Japan
| | - Yuki Ueta
- a Department of Neurology , Tokyo Medical University , Shinjuku-ku , Tokyo , Japan
| | - Haruhisa Kato
- a Department of Neurology , Tokyo Medical University , Shinjuku-ku , Tokyo , Japan
| | - Hiroshi Mitoma
- b Medical Education Promotion Center, Tokyo Medical University , Shinjuku-ku , Tokyo , Japan
| | - Hitoshi Aizawa
- a Department of Neurology , Tokyo Medical University , Shinjuku-ku , Tokyo , Japan
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Le Heron C, Plant O, Manohar S, Ang YS, Jackson M, Lennox G, Hu MT, Husain M. Distinct effects of apathy and dopamine on effort-based decision-making in Parkinson's disease. Brain 2018; 141:1455-1469. [PMID: 29672668 PMCID: PMC5917786 DOI: 10.1093/brain/awy110] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/18/2017] [Accepted: 01/21/2018] [Indexed: 01/30/2023] Open
Abstract
Effort-based decision-making is a cognitive process crucial to normal motivated behaviour. Apathy is a common and disabling complication of Parkinson's disease, but its aetiology remains unclear. Intriguingly, the neural substrates associated with apathy also subserve effort-based decision-making in animal models and humans. Furthermore, the dopaminergic system plays a core role in motivating effortful behaviour for reward, and its dysfunction has been proposed to play a crucial role in the aetiology of apathy in Parkinson's disease. We hypothesized that disrupted effort-based decision-making underlies the syndrome of apathy in Parkinson's disease, and that this disruption may be modulated by the dopaminergic system. An effort-based decision-making task was administered to 39 patients with Parkinson's disease, with and without clinical apathy, ON and OFF their normal dopaminergic medications across two separate sessions, as well as 32 healthy age- and gender-matched controls. On a trial-by-trial basis, participants decided whether to accept or reject offers of monetary reward in return for exerting different levels of physical effort via handheld, individually calibrated dynamometers. Effort and reward were manipulated independently, such that offers spanned the full range of effort/reward combinations. Apathy was assessed using the Lille apathy rating scale. Motor effects of the dopamine manipulation were assessed using the Unified Parkinson's Disease Rating Scale part three motor score. The primary outcome variable was choice (accept/decline offer) analysed using a hierarchical generalized linear mixed effects model, and the vigour of squeeze (Newtons exerted above required force). Both apathy and dopamine depletion were associated with reduced acceptance of offers. However, these effects were driven by dissociable patterns of responding. While apathy was characterized by increased rejection of predominantly low reward offers, dopamine increased responding to high effort, high reward offers, irrespective of underlying motivational state. Dopamine also exerted a main effect on motor vigour, increasing force production independently of reward offered, while apathy did not affect this measure. The findings demonstrate that disrupted effort-based decision-making underlies Parkinson's disease apathy, but in a manner distinct to that caused by dopamine depletion. Apathy is associated with reduced incentivization by the rewarding outcomes of actions. In contrast, dopamine has a general effect in motivating behaviour for high effort, high reward options without altering the response pattern that characterizes the apathetic state. Thus, the motivational deficit observed in Parkinson's disease appears not to be simply secondary to dopaminergic depletion of mesocorticolimbic pathways, suggesting non-dopaminergic therapeutic strategies for apathy may be important future targets.
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Affiliation(s)
- Campbell Le Heron
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Olivia Plant
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Sanjay Manohar
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Yuen-Siang Ang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Matthew Jackson
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Graham Lennox
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
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63
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Santangelo G, D'Iorio A, Maggi G, Cuoco S, Pellecchia MT, Amboni M, Barone P, Vitale C. Cognitive correlates of "pure apathy" in Parkinson's disease. Parkinsonism Relat Disord 2018; 53:101-104. [PMID: 29706433 DOI: 10.1016/j.parkreldis.2018.04.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/16/2018] [Accepted: 04/23/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Previous studies exploring the association between apathy and cognitive deficits in Parkinson's disease (PD) employed scales and questionnaires for apathy, which did not control for the possible confounding effect of motor symptoms. Here we investigated the cognitive correlates of "pure apathy" by the Dimensional Apathy Scale, which allows us to assess apathy minimizing the influence of motor symptoms. METHODS Consecutive PD outpatients referred to our centre were screened. All participants underwent a neuropsychological battery to assess verbal memory, executive functions and visuospatial abilities, apathy and depressive symptoms. RESULTS We enrolled 56 non-depressed and non-demented PD patients, of whom 28 were apathetic and 28 were not. The two groups did not differ on demographic and clinical aspects; apathetic PD patients performed worse than non-apathetic PD patients on the part A, B and B-A of Trail Making Test and the interference task of Stroop test. No significant differences were found on memory and perceptual visuospatial tasks. CONCLUSIONS Our results demonstrated that "pure apathy" is associated with more severe executive dysfunctions such as alteration of set-shifting and inhibitory control, which are mediated by prefrontal cortex and subcortical regions (i.e. basal ganglia). Our findings also supported the hypothesis that co-occurrence of apathy and executive deficits may be the epiphenomenon of damage in prefrontal-striatal cortical circuitries connecting dorsolateral prefrontal cortex, anterior cingulate cortex and basal ganglia.
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Affiliation(s)
- Gabriella Santangelo
- Department of Psychology, University of Campania Luigi Vanvitelli, Viale Ellittico 31, 81100, Caserta, Italy.
| | - Alfonsina D'Iorio
- Department of Psychology, University of Campania Luigi Vanvitelli, Viale Ellittico 31, 81100, Caserta, Italy
| | - Gianpaolo Maggi
- Department of Psychology, University of Campania Luigi Vanvitelli, Viale Ellittico 31, 81100, Caserta, Italy
| | - Sofia Cuoco
- Department of Medicine, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Maria Teresa Pellecchia
- Department of Medicine, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Marianna Amboni
- Department of Medicine, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Paolo Barone
- Department of Medicine, Center for Neurodegenerative Diseases (CEMAND), University of Salerno, Fisciano, Italy
| | - Carmine Vitale
- Department of Motor Sciences and Wellness, University ''Parthenope'', Naples, Italy
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Chagraoui A, Boukhzar L, Thibaut F, Anouar Y, Maltête D. The pathophysiological mechanisms of motivational deficits in Parkinson's disease. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:138-152. [PMID: 29097256 DOI: 10.1016/j.pnpbp.2017.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/21/2017] [Accepted: 10/30/2017] [Indexed: 12/23/2022]
Abstract
Parkinson's disease (PD) is a progressive degenerative disorder that leads to disabling motor symptoms and a wide variety of neuropsychiatric symptoms. Apathy is the most common psychiatric disorder in the early stages of untreated PD and can be defined as a hypodopaminergic syndrome, which also includes anxiety and depression. Apathy is also considered the core feature of the parkinsonian triad (apathy, anxiety and depression) of behavioural non-motor signs, including a motivational deficit. Moreover, apathy is recognised as a distinct chronic neuropsychiatric behavioural disorder based on specific diagnostic criteria. Given the prevalence of apathy in approximately 40% of the general Parkinson's disease population, this appears to be a contributing factor to dementia in PD; also, apathy symptoms are factors that potentially contribute to morbidity, leading to a major impairment of health-related quality of life, thus stressing the importance of understanding the pathophysiology of this disease. Several studies have clearly established a prominent role for DA-mediated signals in PD apathy. However, synergistic interaction between dopaminergic impairment resulting from the neurodegenerative process and deep brain stimulation of the subthalamic nucleus may cause or exacerbate apathy. Furthermore, serotoninergic mechanism signalling is also likely to be of importance in this pathophysiology.
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Affiliation(s)
- A Chagraoui
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France.; Department of Medical Biochemistry, Rouen University Hospital, Rouen, France.
| | - L Boukhzar
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France
| | - F Thibaut
- Department of Psychiatry, University Hospital Cochin (site Tarnier), University of Paris-Descartes and INSERM U 894 Laboratory of Psychiatry and Neurosciences, Paris, France
| | - Y Anouar
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France
| | - D Maltête
- Department of Neurology, Rouen University Hospital, Rouen, France
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65
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Ye BS, Jeon S, Yoon S, Kang SW, Baik K, Lee Y, Chung SJ, Oh JS, Moon H, Kim JS, Lee PH, Sohn YH. Effects of dopaminergic depletion and brain atrophy on neuropsychiatric symptoms in de novo Parkinson's disease. J Neurol Neurosurg Psychiatry 2018; 89:197-204. [PMID: 28951497 DOI: 10.1136/jnnp-2017-316075] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/03/2017] [Accepted: 09/11/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms impact the patients' quality of life and caregivers' burdens in Parkinson's disease (PD). We aimed to investigate the effects of striatal dopaminergic depletion and brain atrophy on the neuropsychiatric symptoms of patients with PD. METHODS Two hundred and seven patients with de novo drug-naïve PD underwent dopamine transporter (DAT) positron emission tomography and brain MRI scanning. In addition, the patients were assessed with caregiver-administered neuropsychiatric inventory (NPI) questionnaires. To evaluate the effects of DAT uptake, subcortical volume and cortical thinning on the patients' neuropsychiatric symptoms, we performed logistic regression and negative binomial regression analyses on the NPI data after controlling for possible confounders. RESULTS Frontal cortical thinning was associated with the presence of nighttime behaviour and irritability, and the thinning correlated with the severity of the nighttime behaviour. Temporal cortical thinning was associated with the presence of aggression/agitation, and it correlated with the severity of the aggression/agitation. Subcortical atrophy in the accumbens was associated with the presence of disinhibition and correlated with the severity of the disinhibition. Putamen atrophy and insular thinning were independently associated with the presence of apathy, but only insular thinning correlated with the severity of the apathy. Of the predictors, only frontal cortical thinning correlated with the total NPI score. CONCLUSIONS The results of this study suggested that accumbens atrophy and frontotemporal cortical thinning, especially frontal cortical thinning, independently contributed to neuropsychiatric symptoms in patients with PD, while DAT uptake did not affect the neuropsychiatric symptoms.
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Affiliation(s)
- Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seun Jeon
- McGill Center for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Sohoon Yoon
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Woo Kang
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - KyoungWon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoonju Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jungsu S Oh
- Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Hyojeong Moon
- Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ho Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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66
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de Natale ER, Niccolini F, Wilson H, Politis M. Molecular Imaging of the Dopaminergic System in Idiopathic Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 141:131-172. [DOI: 10.1016/bs.irn.2018.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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67
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Wen MC, Chan LL, Tan LCS, Tan EK. Depression, anxiety, and apathy in Parkinson's disease: insights from neuroimaging studies. Eur J Neurol 2017; 23:1001-19. [PMID: 27141858 PMCID: PMC5084819 DOI: 10.1111/ene.13002] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/01/2016] [Indexed: 11/28/2022]
Abstract
Depression, anxiety and apathy are common mood disturbances in Parkinson's disease (PD) but their pathophysiology is unclear. Advanced neuroimaging has been increasingly used to unravel neural substrates linked to these disturbances. A systematic review is provided of neuroimaging findings in depression, anxiety and apathy in PD. A PubMed, MEDLINE and EMBASE search of peer‐reviewed original research articles on these mood disturbances in PD identified 38 studies on depression, eight on anxiety and 14 on apathy in PD. Most of the imaging studies used either position emission tomography or single‐photon emission computed tomography techniques. These studies generally suggest increased neural activity in the prefrontal regions and decreased functional connectivity between the prefrontal−limbic networks in depressed patients. Functional imaging studies revealed an inverse correlation between dopaminergic density in the caudate and putamen with the severity of anxiety in PD. There was no consistent correlation between dopaminergic density of thalamus and anxiety. Studies demonstrated both positive and inverse correlations between apathy and metabolism or activity in the striatum, amygdalar, prefrontal, temporal and parietal regions. The clinical variability of study subjects and differences in image pre‐processing and analytical strategies may contribute to discrepant findings in these studies. Both nigrostriatal and extra‐nigrostriatal pathways (in particular the frontal region and its connecting areas) are affected in mood disorders in PD. Identifying the relative contributions of these neural pathways in PD patients with overlapping motor and mood symptoms could provide new pathophysiological clues for the development of better therapeutic targets for affected patients.
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Affiliation(s)
- M-C Wen
- Department of Research, National Neuroscience Institute, Singapore, Singapore
| | - L L Chan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - L C S Tan
- Duke - National University of Singapore Graduate Medical School, Singapore, Singapore.,Department of Neurology, National Neuroscience Institute, Singapore
| | - E K Tan
- Department of Research, National Neuroscience Institute, Singapore, Singapore.,Duke - National University of Singapore Graduate Medical School, Singapore, Singapore.,Department of Neurology, National Neuroscience Institute, Singapore
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68
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Jahanshahi M, Rothwell JC. Inhibitory dysfunction contributes to some of the motor and non-motor symptoms of movement disorders and psychiatric disorders. Philos Trans R Soc Lond B Biol Sci 2017; 372:rstb.2016.0198. [PMID: 28242732 DOI: 10.1098/rstb.2016.0198] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2016] [Indexed: 12/13/2022] Open
Abstract
Recently, it has been proposed that similar to goal-directed and habitual action mediated by the fronto-striatal circuits, the fronto-striato-subthalamic-pallidal-thalamo-cortical network may also mediate goal-directed and habitual (automatic) inhibition in both the motor and non-motor domains. Within this framework, some of the clinical manifestations of Parkinson's disease, dystonia, Tourette syndrome and obsessive-compulsive disorder can be considered to represent an imbalance between goal-directed and habitual action and inhibition. It is possible that surgical interventions targeting the basal ganglia nuclei, such as deep brain stimulation of the subthalamic nucleus or the internal segment of the globus pallidus, improve these disorders by restoring a functional balance between facilitation and inhibition in the fronto-striatal networks. These proposals require investigation in future studies.This article is part of the themed issue 'Movement suppression: brain mechanisms for stopping and stillness'.
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Affiliation(s)
- Marjan Jahanshahi
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK
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69
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Del-Monte J, Bayard S, Graziani P, Gély-Nargeot MC. Cognitive, Emotional, and Auto-Activation Dimensions of Apathy in Parkinson's Disease. Front Behav Neurosci 2017; 11:230. [PMID: 29209182 PMCID: PMC5702439 DOI: 10.3389/fnbeh.2017.00230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 11/07/2017] [Indexed: 02/02/2023] Open
Abstract
Apathy is one of the most frequent non-motor manifestations in Parkinson's disease (PD) that can lead to a whole range of deleterious outcomes. In 2006, Levy and Dubois proposed a model that distinguishes three different apathy aetiologies in PD divided into three subtypes of disrupted processing: “emotional-affective,” “cognitive,” and “auto-activation.” These three dimensions associated with dopamine depletion present in the pathology would lead to the emergence of apathy in PD. The aim of this mini-review was to describe and discuss studies that have explore links between apathy and the three subtypes of disrupted processing proposed by Levy and Dubois (2006) and as well as the links between these dimensions and dopamine depletion in Parkinson's disease. The lack of consensus regarding the emotional-affective correlates of apathy and the lack of evidence supporting the hypothesis of the auto-activation deficit, do not clearly confirm the validity of Levy and Dubois's model. Furthermore, the suggested association between dopaminergic depletion and apathy must also be clarified.
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Affiliation(s)
- Jonathan Del-Monte
- Social Psychology Laboratory EA 849, Aix-Marseille and Nîmes Universities, Nîmes, France
| | - Sophie Bayard
- Epsylon, Laboratory Dynamic of Human Abilities & Health Behaviors, Department of Sport Sciences, Psychology and Medicine, Montpellier University, Montpellier, France
| | - Pierluigi Graziani
- Social Psychology Laboratory EA 849, Aix-Marseille and Nîmes Universities, Nîmes, France
| | - Marie C Gély-Nargeot
- Epsylon, Laboratory Dynamic of Human Abilities & Health Behaviors, Department of Sport Sciences, Psychology and Medicine, Montpellier University, Montpellier, France
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70
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Separate neural representations of depression, anxiety and apathy in Parkinson's disease. Sci Rep 2017; 7:12164. [PMID: 28939804 PMCID: PMC5610322 DOI: 10.1038/s41598-017-12457-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/29/2017] [Indexed: 01/12/2023] Open
Abstract
Depression, anxiety and apathy are distinct neuropsychiatric symptoms that highly overlap in Parkinson’s disease (PD). It remains unknown whether each symptom is uniquely associated with a functional network dysfunction. Here, we examined whether individual differences in each neuropsychiatric symptom predict functional connectivity patterns in PD patients while controlling for all other symptoms and motor function. Resting-state functional connectivity MRI were acquired from 27 PD patients and 29 healthy controls. Widespread reduced functional connectivity was identified in PD patients and explained by either the neuropsychiatric or motor symptoms. Depression in PD predicted increased functional connectivity between the orbitofrontal, hippocampal complex, cingulate, caudate and thalamus. Apathy in PD predicted decreased caudate-thalamus and orbitofrontal-parahippocampal connectivity. Anxiety in PD predicted three distinct types of functional connectivity not described before: (i) increased limbic-orbitofrontal cortex; (ii) decreased limbic-dorsolateral prefrontal cortex and orbitofrontal-dorsolateral prefrontal cortices and (iii) decreased sensorimotor-orbitofrontal cortices. The first two types of functional connectivity suggest less voluntary and more automatic emotion regulation. The last type is argued to be specific to PD and reflect an impaired ability of the orbitofrontal cortex to guide goal-directed motor actions in anxious PD patients.
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71
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Thobois S, Prange S, Sgambato-Faure V, Tremblay L, Broussolle E. Imaging the Etiology of Apathy, Anxiety, and Depression in Parkinson's Disease: Implication for Treatment. Curr Neurol Neurosci Rep 2017; 17:76. [PMID: 28822071 DOI: 10.1007/s11910-017-0788-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Apathy, depression, and anxiety are among the most important non-motor signs of Parkinson's disease (PD). This may be encountered at early stages of illness and represent a major source of burden. Understanding their pathophysiology is a major prerequisite for efficient therapeutic strategies. Anatomical and metabolic imaging studies have enabled a breakthrough by demonstrating that widespread abnormalities within the limbic circuits notably the orbitofrontal and anterior cingulate cortices, amygdala, thalamus, and ventral striatum are involved in the pathophysiology of depression, anxiety, and apathy in PD. Functional imaging has further shown that mesolimbic dopaminergic but also serotonergic lesions play a major role in the mechanisms of these three neuropsychiatric manifestations, which has direct therapeutic implications.
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Affiliation(s)
- Stephane Thobois
- Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, Lyon, France. .,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de neurologie C, Centre Expert Parkinson, Lyon, France. .,Université de Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.
| | - Stephane Prange
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de neurologie C, Centre Expert Parkinson, Lyon, France.,Université de Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France
| | - Véronique Sgambato-Faure
- Université de Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France
| | - Léon Tremblay
- Université de Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France
| | - Emmanuel Broussolle
- Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, Lyon, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de neurologie C, Centre Expert Parkinson, Lyon, France.,Université de Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France
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72
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Apathy in drug-naïve patients with Parkinson's disease. Parkinsonism Relat Disord 2017; 44:28-32. [PMID: 28844367 DOI: 10.1016/j.parkreldis.2017.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/19/2017] [Accepted: 08/08/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study is to explore the prevalence and clinical correlates of apathy in early-stage Parkinson's disease (PD) from a cohort of Chinese patients. METHODS A cross-sectional analysis of 133 treatment-naive PD patients was conducted. Each subject was categorized as PD with or without apathy using the Lille Apathy Rating Scale (LARS). RESULTS Of 133 patients, 30 PD patients (22.56%) reported apathy, of whom 23 (17.29%) did not have concomitant depression. The stepwise binary logistic regression model indicated that the lower Frontal assessment battery (FAB) score (OR = 0.623, 95% CI = 0.466-0.834, P = 0.001), the higher sleep/fatigue score from the Non-Motor Symptoms Scale (NMSS) (OR = 1.171, 95% CI = 1.071-1.279, P = 0.001), the higher Hamilton Depression Rating Scale including 24 items (HAMD-24) score (OR = 1.112, 95% CI = 1.005-1.230, P = 0.039) and the higher Unified Parkinson's Disease Rating Scale (UPDRS) part III score (OR = 1.119, 95% CI = 1.045-1.198, P = 0.001) were associated with apathy. No significant associations were found between apathy and other parameters such as age, sex distribution, disease duration, anxiety, Fatigue Severity Scale (FSS) score, Montreal Cognitive Assessment (MOCA) score and remaining domain scores for NMSS. CONCLUSIONS Apathy is not rare (22.56%) in Chinese treatment-naïve PD patients. Apathy in PD is not only related to the severity of motor symptoms of the disease but also to some non-motor symptoms, such as executive dysfunction, depression and sleep disturbances.
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73
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Sauerbier A, Rosa-Grilo M, Qamar MA, Chaudhuri KR. Nonmotor Subtyping in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:447-478. [PMID: 28802928 DOI: 10.1016/bs.irn.2017.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Nonmotor symptoms are integral to Parkinson's disease. Several subtypes dominated by specific nonmotor symptoms have emerged. In this chapter, the rationale behind nonmotor subtyping and currently proposed nonmotor subgroups within Parkinson's disease based on data-driven cluster analysis and clinical observations will be summarized. Furthermore, the concept of seven clinical nonmotor subtypes will be discussed in detail including the clinical presentation, potential biomarkers, and the clinical relevance. In future, nonmotor subtypes will possibly play a major role within the aim to achieve personalized medicine.
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Affiliation(s)
- Anna Sauerbier
- Parkinson's Centre of Excellence, King's College Hospital Foundation Trust, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom.
| | - Miguel Rosa-Grilo
- Parkinson's Centre of Excellence, King's College Hospital Foundation Trust, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Mubasher A Qamar
- Parkinson's Centre of Excellence, King's College Hospital Foundation Trust, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - K Ray Chaudhuri
- Parkinson's Centre of Excellence, King's College Hospital Foundation Trust, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
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74
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Yousaf T, Wilson H, Politis M. Imaging the Nonmotor Symptoms in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:179-257. [PMID: 28802921 DOI: 10.1016/bs.irn.2017.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Parkinson's disease is acknowledged to be a multisystem syndrome, manifesting as a result of multineuropeptide dysfunction, including dopaminergic, cholinergic, serotonergic, and noradrenergic deficits. This multisystem disorder ultimately leads to the presentation of a range of nonmotor symptoms, now appreciated to be an integral part of the disease-specific spectrum of symptoms, often preceding the diagnosis of motor Parkinson's disease. In this chapter, we review the dopaminergic and nondopaminergic basis of these symptoms by exploring the neuroimaging evidence based on several techniques including positron emission tomography, single-photon emission computed tomography molecular imaging, magnetic resonance imaging, functional magnetic resonance imaging, and diffusion tensor imaging. We discuss the role of these neuroimaging techniques in elucidating the underlying pathophysiology of NMS in Parkinson's disease.
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Affiliation(s)
- Tayyabah Yousaf
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Heather Wilson
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Marios Politis
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom.
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75
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Santangelo G, Siciliano M, Trojano L, Femiano C, Monsurrò MR, Tedeschi G, Trojsi F. Apathy in amyotrophic lateral sclerosis: insights from Dimensional Apathy Scale. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:434-442. [DOI: 10.1080/21678421.2017.1313865] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Gabriella Santangelo
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy,
- IDC-Hermitage-Capodimonte, Naples, Italy,
| | - Mattia Siciliano
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy,
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy, and
| | - Luigi Trojano
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy,
- Salvatore Maugeri Foundation, Scientific Institute of Telese, Telese, Terme, BN, Italy
| | - Cinzia Femiano
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy, and
| | - Maria Rosaria Monsurrò
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy, and
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy, and
| | - Francesca Trojsi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy, and
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76
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Moretti R, Caruso P, Dal Ben M. Rivastigmine as a Symptomatic Treatment for Apathy in Parkinson's Dementia Complex: New Aspects for This Riddle. PARKINSON'S DISEASE 2017; 2017:6219851. [PMID: 28409049 PMCID: PMC5376458 DOI: 10.1155/2017/6219851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/17/2017] [Accepted: 03/02/2017] [Indexed: 12/26/2022]
Abstract
Over 90% of PDD patients show at least one neuropsychiatric symptom (NPS); in the 60-70% two or more NPS are present. Their incidence is important in terms of prognosis and severity of pathology. However, among all NPS, apathy is often the most disturbing, associated with greater caregiver's burden. Similar to other NPS, apathy may be due to a dysfunction of the nigrostriatal pathway, even though, not all the PD patients become apathetic, indicating that apathy should not entirely be considered a dopamine-dependent syndrome, and in fact it might also be related to acetylcholine defects. Apathy has been treated in many ways, without sure benefits; among these, Rivastigmine may present benefic properties. We present a series of 48 patients, suffering from PDD, treated with Rivastigmine, and followed-up for one year; they have been devotedly studied for apathy, even though all the other NPS disorders have been registered. Rivastigmine did not have a prolonged benefic effect on apathy, in our work, on the contrary of what had been observed in the literature, probably due to the longer follow-up of our patients.
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Affiliation(s)
- Rita Moretti
- Clinica Neurologica, Dipartimento Universitario Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
| | - Paola Caruso
- Clinica Neurologica, Dipartimento Universitario Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
| | - Matteo Dal Ben
- FIF Science Park, University of Trieste, Trieste, Italy
- Dipartimento Universitario Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
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77
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Picillo M, Santangelo G, Erro R, Cozzolino A, Amboni M, Vitale C, Barone P, Pellecchia MT. Association between dopaminergic dysfunction and anxiety in de novo Parkinson's disease. Parkinsonism Relat Disord 2017; 37:106-110. [PMID: 28214265 DOI: 10.1016/j.parkreldis.2017.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/23/2017] [Accepted: 02/08/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To explore the relationships between nigrostriatal dysfunction and neuropsychiatric symptoms (including anxiety, depression and apathy) in a large cohort of newly diagnosed, drug-naïve Parkinson disease (PD) patients compared to a cohort of healthy controls (HC). METHODS This is a cross-sectional analysis of the Parkinson's Progression Markers Initiative (PPMI) cohort at baseline, including 405 PD patients and 187 HC. Nigrostriatal degeneration was evaluated by means of SPECT DAT scan. Relationships between neuropsychiatric symptoms and DAT uptakes were analysed by means of stepwise multiple regression analysis. RESULTS In the PD group, lower DAT uptake in the right caudate was associated with higher STAI trait subscore (β = -2.939, 95%CI: -4.634 to -1.254, p = 0.001). Depression and apathy scores were not related with DAT uptakes. No associations were found in the HC group. CONCLUSIONS Our cross-sectional analysis of the PPMI data shows that lower caudate DAT uptake is associated with higher level of anxiety. The data strengthens the relationship between dopaminergic dysfunction and neuropsychiatric symptoms in early PD.
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Affiliation(s)
- Marina Picillo
- Centre for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Salerno, Italy
| | - Gabriella Santangelo
- Neuropsychology Laboratory, Department of Psychology, Second University of Naples, Caserta, Italy
| | - Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK; Dipartimento di Scienze Neurologiche e del Movimento, Università di Verona, Verona, Italy
| | - Autilia Cozzolino
- Centre for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Salerno, Italy
| | - Marianna Amboni
- Centre for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Salerno, Italy; IDC Hermitage-Capodimonte, Naples, Italy
| | - Carmine Vitale
- IDC Hermitage-Capodimonte, Naples, Italy; University of Naples Parthenope, Naples, Italy
| | - Paolo Barone
- Centre for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Salerno, Italy
| | - Maria Teresa Pellecchia
- Centre for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Salerno, Italy.
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78
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Qamar MA, Sauerbier A, Politis M, Carr H, Loehrer PA, Chaudhuri KR. Presynaptic dopaminergic terminal imaging and non-motor symptoms assessment of Parkinson's disease: evidence for dopaminergic basis? NPJ Parkinsons Dis 2017; 3:5. [PMID: 28649605 PMCID: PMC5445592 DOI: 10.1038/s41531-016-0006-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/04/2016] [Accepted: 11/25/2016] [Indexed: 02/08/2023] Open
Abstract
Parkinson's disease (PD) is now considered to be a multisystemic disorder consequent on multineuropeptide dysfunction including dopaminergic, serotonergic, cholinergic, and noradrenergic systems. This multipeptide dysfunction leads to expression of a range of non-motor symptoms now known to be integral to the concept of PD and preceding the diagnosis of motor PD. Some non-motor symptoms in PD may have a dopaminergic basis and in this review, we investigate the evidence for this based on imaging techniques using dopamine-based radioligands. To discuss non-motor symptoms we follow the classification as outlined by the validated PD non-motor symptoms scale.
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Affiliation(s)
- MA Qamar
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - A Sauerbier
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - M Politis
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - H Carr
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - P A Loehrer
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - K Ray Chaudhuri
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
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79
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Szatmari S, Illigens BMW, Siepmann T, Pinter A, Takats A, Bereczki D. Neuropsychiatric symptoms in untreated Parkinson's disease. Neuropsychiatr Dis Treat 2017; 13:815-826. [PMID: 28352181 PMCID: PMC5360401 DOI: 10.2147/ndt.s130997] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Neuropsychiatric and cognitive symptoms are common in Parkinson's disease (PD) and may precede and exceed motor symptoms as major factors impacting disease course and quality of life. Neuropsychiatric symptoms (NPS) in PD are various and are attributed to pathologic changes within multiple brain regions, to psychological stress, and to adverse effects of dopamine replacement therapy. Sleep disorders and mood symptoms such as apathy, depression, and anxiety may antedate the development of motor symptoms by years, while other NPS such as impulse control disorders, psychosis, and cognitive impairment are more common in later stages of the disease. Few studies report on NPS in the early, untreated phase of PD. We reviewed the current literature on NPS in PD with a focus on the early, drug-naive stages of PD. Among these early disease stages, premotor and early motor phases were separately addressed in our review, highlighting the underlying pathophysiological mechanisms as well as epidemiological characteristics, clinical features, risk factors, and available techniques of clinical assessment.
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Affiliation(s)
- Szabolcs Szatmari
- Department of Neurology, Sibiu County Emergency Hospital, Sibiu; 2nd Department of Neurology, Targu Mures Emergency Clinical County Hospital, Targu Mures, Romania; János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Timo Siepmann
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University; Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Alexandra Pinter
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University; Department of Family Medicine
| | - Annamaria Takats
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
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80
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Biomarkers of Nonmotor Symptoms in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:259-289. [DOI: 10.1016/bs.irn.2017.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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81
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Ehgoetz Martens KA, Lewis SJG. Pathology of behavior in PD: What is known and what is not? J Neurol Sci 2016; 374:9-16. [PMID: 28089250 DOI: 10.1016/j.jns.2016.12.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/28/2016] [Indexed: 12/12/2022]
Abstract
Abnormal behavior in Parkinson's disease (PD) stems from a complex orchestration of impaired neural networks that result from PD-related neurodegeneration across multiple levels. Typically, cellular and tissue abnormalities generate neurochemical changes and disrupt specific regions of the brain, in turn creating impaired neural circuits and dysfunctional global networks. The objective of this chapter is to provide an overview of the array of pathological changes that have been linked to different behavioral symptoms of PD such as depression, anxiety, apathy, fatigue, impulse control disorders, psychosis, sleep disorders and dementia.
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Affiliation(s)
- Kaylena A Ehgoetz Martens
- Parkinson Disease Research Clinic, Brain and Mind Centre, University of Sydney, 100 Mallet Street, Camperdown, 2050, NSW, Australia.
| | - Simon J G Lewis
- Parkinson Disease Research Clinic, Brain and Mind Centre, University of Sydney, 100 Mallet Street, Camperdown, 2050, NSW, Australia
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82
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Borgonovo J, Allende-Castro C, Laliena A, Guerrero N, Silva H, Concha ML. Changes in neural circuitry associated with depression at pre-clinical, pre-motor and early motor phases of Parkinson's disease. Parkinsonism Relat Disord 2016; 35:17-24. [PMID: 27889469 DOI: 10.1016/j.parkreldis.2016.11.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/08/2016] [Accepted: 11/18/2016] [Indexed: 12/17/2022]
Abstract
Although Parkinson's Disease (PD) is mostly considered a motor disorder, it can present at early stages as a non-motor pathology. Among the non-motor clinical manifestations, depression shows a high prevalence and can be one of the first clinical signs to appear, even a decade before the onset of motor symptoms. Here, we review the evidence of early dysfunction in neural circuitry associated with depression in the context of PD, focusing on pre-clinical, pre-motor and early motor phases of the disease. In the pre-clinical phase, structural and functional changes in the substantia nigra, basal ganglia and limbic structures are already observed. Some of these changes are linked to motor compensation mechanisms while others correspond to pathological processes common to PD and depression and thus could underlie the appearance of depressive symptoms during the pre-motor phase. Studies of the early motor phase (less than five years post diagnosis) reveal an association between the extent of damage in different monoaminergic systems and the appearance of emotional disorders. We propose that the limbic loop of the basal ganglia and the lateral habenula play key roles in the early genesis of depression in PD. Alterations in the neural circuitry linked with emotional control might be sensitive markers of the ongoing neurodegenerative process and thus may serve to facilitate an early diagnosis of this disease. To take advantage of this, we need to improve the clinical criteria and develop biomarkers to identify depression, which could be used to determine individuals at risk to develop PD.
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Affiliation(s)
- Janina Borgonovo
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile
| | - Camilo Allende-Castro
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile
| | - Almudena Laliena
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile
| | - Néstor Guerrero
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile
| | - Hernán Silva
- Department of Psychiatry and Mental Health, Clinical Hospital, Universidad de Chile, Santiago, Chile
| | - Miguel L Concha
- Anatomy and Developmental Biology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, PO Box 70031, Santiago, Chile; Biomedical Neuroscience Institute, Independencia 1027, Santiago, Chile; Center for Geroscience, Brain Health and Metabolism, Santiago, Chile.
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83
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Different clinical features in siblings with identical mutations of the Parkin gene (PARK2). J Neurol Sci 2016; 368:147-9. [DOI: 10.1016/j.jns.2016.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/31/2016] [Accepted: 07/01/2016] [Indexed: 11/17/2022]
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Maillet A, Krack P, Lhommée E, Météreau E, Klinger H, Favre E, Le Bars D, Schmitt E, Bichon A, Pelissier P, Fraix V, Castrioto A, Sgambato-Faure V, Broussolle E, Tremblay L, Thobois S. The prominent role of serotonergic degeneration in apathy, anxiety and depression inde novoParkinson’s disease. Brain 2016; 139:2486-502. [DOI: 10.1093/brain/aww162] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/27/2016] [Indexed: 01/09/2023] Open
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Conti MM, Meadows SM, Melikhov-Sosin M, Lindenbach D, Hallmark J, Werner DF, Bishop C. Monoamine transporter contributions to l-DOPA effects in hemi-parkinsonian rats. Neuropharmacology 2016; 110:125-134. [PMID: 27452719 DOI: 10.1016/j.neuropharm.2016.07.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/30/2016] [Accepted: 07/20/2016] [Indexed: 11/30/2022]
Abstract
l-DOPA is the standard treatment for Parkinson's disease (PD), but chronic treatment typically leads to abnormal involuntary movement or dyskinesia (LID) development. Although poorly understood, dyskinetic mechanisms involve a complex interaction between the remaining dopamine system and the semi-homologous serotonin and norepinephrine systems. Serotonin and norepinephrine transporters (SERT and NET, respectively) have affinity for dopamine uptake especially when dopamine transporters (DAT) are scant. Monoamine reuptake inhibitors have been reported to modulate l-DOPA's anti-parkinsonian effects, but DAT, SERT, and NET's contribution to dyskinesia has not been well delineated. The current investigation sought to uncover the differential expression and function of DAT, SERT, and NET in the l-DOPA-treated hemi-parkinsonian rat. Protein analysis of striatal monoamine transporters in unilateral sham or 6-hydroxydopamine-lesioned rats treated with l-DOPA (0 or 6 mg/kg) showed lesion-induced DAT loss and l-DOPA-induced gain in SERT:DAT and NET:DAT ratios in lesioned rats which positively correlated with dyskinesia expression, suggesting functional shifts among monoamine transporters in the dyskinetic state. SERT blockade with citalopram (3, 5 mg/kg) reduced LID while DAT and NET blockade with GBR-12909 (5, 10 mg/kg) and nisoxetine (5, 10 mg/kg), respectively, mildly exacerbated dyskinesia expression. Transporter inhibition did not significantly alter l-DOPA's ability to reverse motor deficit. Overall, DA and DAT loss with l-DOPA treatment appear to precipitate gain in SERT and NET function. Strong correlations with LID and direct behavioral comparisons of selective transporter blockade reveal novel implications for SERT, DAT, and NET as potential biomarkers and therapeutic targets in the hemi-parkinsonian model and dyskinetic PD patients.
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Affiliation(s)
- Melissa M Conti
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, 4400 Vestal Parkway East, Binghamton, NY 13902-6000, USA
| | - Samantha M Meadows
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, 4400 Vestal Parkway East, Binghamton, NY 13902-6000, USA
| | - Mitchell Melikhov-Sosin
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, 4400 Vestal Parkway East, Binghamton, NY 13902-6000, USA
| | - David Lindenbach
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, 4400 Vestal Parkway East, Binghamton, NY 13902-6000, USA
| | - Joy Hallmark
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, 4400 Vestal Parkway East, Binghamton, NY 13902-6000, USA
| | - David F Werner
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, 4400 Vestal Parkway East, Binghamton, NY 13902-6000, USA
| | - Christopher Bishop
- Behavioral Neuroscience Program, Department of Psychology, Binghamton University, 4400 Vestal Parkway East, Binghamton, NY 13902-6000, USA.
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Castrioto A, Thobois S, Carnicella S, Maillet A, Krack P. Emotional manifestations of PD: Neurobiological basis. Mov Disord 2016; 31:1103-13. [DOI: 10.1002/mds.26587] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/22/2016] [Accepted: 01/24/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Anna Castrioto
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GINGrenoble France
- InsermU1216Grenoble France
- Movement Disorders Unit, Neurology Department, CHU de GrenobleGrenoble France
| | - Stéphane Thobois
- CNRS, UMR 5229, Centre de Neurosciences CognitivesBron France
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C; Université Lyon I, Faculté de Médecine et de Maïeutique Lyon Sud Charles MérieuxLyon France
| | - Sebastien Carnicella
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GINGrenoble France
- InsermU1216Grenoble France
| | - Audrey Maillet
- CNRS, UMR 5229, Centre de Neurosciences CognitivesBron France
| | - Paul Krack
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GINGrenoble France
- InsermU1216Grenoble France
- Movement Disorders Unit, Neurology Department, CHU de GrenobleGrenoble France
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87
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Apathy and striatal dopamine defects in non-demented patients with Parkinson's disease. Parkinsonism Relat Disord 2016; 23:62-5. [DOI: 10.1016/j.parkreldis.2015.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/30/2015] [Accepted: 12/04/2015] [Indexed: 11/30/2022]
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88
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Picillo M, Santangelo G, Moccia M, Erro R, Amboni M, Prestipino E, Longo K, Vitale C, Spina E, Orefice G, Barone P, Pellecchia MT. Serum uric acid is associated with apathy in early, drug-naïve Parkinson’s disease. J Neural Transm (Vienna) 2016; 123:371-7. [DOI: 10.1007/s00702-015-1502-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/27/2015] [Indexed: 11/25/2022]
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Hassan A, Benarroch EE. Heterogeneity of the midbrain dopamine system: Implications for Parkinson disease. Neurology 2015; 85:1795-805. [PMID: 26475693 DOI: 10.1212/wnl.0000000000002137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Anhar Hassan
- From the Department of Neurology, Mayo Clinic, Rochester, MN.
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