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Gerstenecker A. The Neuropsychology (Broadly Conceived) of Multiple System Atrophy, Progressive Supranuclear Palsy, and Corticobasal Degeneration. Arch Clin Neuropsychol 2017; 32:861-875. [DOI: 10.1093/arclin/acx093] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/30/2017] [Indexed: 11/14/2022] Open
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Ou R, Liu H, Hou Y, Wei Q, Cao B, Zhao B, Shang H. Executive dysfunction, behavioral changes and quality of life in Chinese patients with progressive supranuclear palsy. J Neurol Sci 2017; 380:182-186. [DOI: 10.1016/j.jns.2017.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 07/22/2017] [Accepted: 07/23/2017] [Indexed: 10/19/2022]
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Bhatia KP, Stamelou M. Nonmotor Features in Atypical Parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1285-1301. [PMID: 28805573 DOI: 10.1016/bs.irn.2017.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Atypical parkinsonism (AP) comprises mainly multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD), which are distinct pathological entities, presenting with a wide phenotypic spectrum. The classic syndromes are now called MSA-parkinsonism (MSA-P), MSA-cerebellar type (MSA-C), Richardson's syndrome, and corticobasal syndrome. Nonmotor features in AP have been recognized almost since the initial description of these disorders; however, research has been limited. Autonomic dysfunction is the most prominent nonmotor feature of MSA, but also gastrointestinal symptoms, sleep dysfunction, and pain, can be a feature. In PSP and CBD, the most prominent nonmotor symptoms comprise those deriving from the cognitive/neuropsychiatric domain. Apart from assisting the clinician in the differential diagnosis with Parkinson's disease, nonmotor features in AP have a big impact on quality of life and prognosis of AP and their treatment poses a major challenge for clinicians.
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Affiliation(s)
| | - Maria Stamelou
- HYGEIA Hospital, Athens, Greece; Neurology Clinic, Philipps University Marburg, Marburg, Germany; University of Athens, Athens, Greece.
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Respondek G, Kurz C, Arzberger T, Compta Y, Englund E, Ferguson LW, Gelpi E, Giese A, Irwin DJ, Meissner WG, Nilsson C, Pantelyat A, Rajput A, van Swieten JC, Troakes C, Josephs KA, Lang AE, Mollenhauer B, Müller U, Whitwell JL, Antonini A, Bhatia KP, Bordelon Y, Corvol JC, Colosimo C, Dodel R, Grossman M, Kassubek J, Krismer F, Levin J, Lorenzl S, Morris H, Nestor P, Oertel WH, Rabinovici GD, Rowe JB, van Eimeren T, Wenning GK, Boxer A, Golbe LI, Litvan I, Stamelou M, Höglinger GU. Which ante mortem clinical features predict progressive supranuclear palsy pathology? Mov Disord 2017; 32:995-1005. [PMID: 28500752 PMCID: PMC5543934 DOI: 10.1002/mds.27034] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/08/2017] [Accepted: 04/10/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a neuropathologically defined disease presenting with a broad spectrum of clinical phenotypes. OBJECTIVE To identify clinical features and investigations that predict or exclude PSP pathology during life, aiming at an optimization of the clinical diagnostic criteria for PSP. METHODS We performed a systematic review of the literature published since 1996 to identify clinical features and investigations that may predict or exclude PSP pathology. We then extracted standardized data from clinical charts of patients with pathologically diagnosed PSP and relevant disease controls and calculated the sensitivity, specificity, and positive predictive value of key clinical features for PSP in this cohort. RESULTS Of 4166 articles identified by the database inquiry, 269 met predefined standards. The literature review identified clinical features predictive of PSP, including features of the following 4 functional domains: ocular motor dysfunction, postural instability, akinesia, and cognitive dysfunction. No biomarker or genetic feature was found reliably validated to predict definite PSP. High-quality original natural history data were available from 206 patients with pathologically diagnosed PSP and from 231 pathologically diagnosed disease controls (54 corticobasal degeneration, 51 multiple system atrophy with predominant parkinsonism, 53 Parkinson's disease, 73 behavioral variant frontotemporal dementia). We identified clinical features that predicted PSP pathology, including phenotypes other than Richardson's syndrome, with varying sensitivity and specificity. CONCLUSIONS Our results highlight the clinical variability of PSP and the high prevalence of phenotypes other than Richardson's syndrome. The features of variant phenotypes with high specificity and sensitivity should serve to optimize clinical diagnosis of PSP. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gesine Respondek
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases, Munich, Germany
| | - Carolin Kurz
- Department of Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany
| | - Thomas Arzberger
- German Center for Neurodegenerative Diseases, Munich, Germany
- Department of Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University, Munich, Germany
| | - Yaroslau Compta
- Parkinson's Disease & Movement Disorders Unit, Neurology Service, Hospital Clinic/IDIBAPS/University of Barcelona/CIBERNED, Barcelona, Catalonia, Spain
| | - Elisabet Englund
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Leslie W Ferguson
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatchewan, Canada
| | - Ellen Gelpi
- Neurological Tissue Bank and Neurology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, CERCA, Barcelona, Catalonia, Spain
| | - Armin Giese
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University, Munich, Germany
| | - David J Irwin
- Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Pennsylvania, USA
| | - Wassilios G Meissner
- University of Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- Centre national de la recherche scientifique (CNRS), Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Christer Nilsson
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | | | - Alex Rajput
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatchewan, Canada
| | - John C van Swieten
- Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Claire Troakes
- London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Canada
| | - Brit Mollenhauer
- Paracelsus-Elena Klinik Kassel and University Medical Center Goettingen, Institute of Neuropathology, Goettingen, Germany
| | | | | | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Istituto di ricovero e cura a carattere scientifico (IRCCS) Hospital San Camillo and Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Jean-Christophe Corvol
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC Univ) Paris 06; and INSERM UMRS_1127, CIC_1422; and CNRS UMR_7225; and Assistance publique - Hôpitaux de Paris (AP-HP); and Institut du Cerveau et de la Moelle Epinière (ICM), Hôpital Pitié-Salpêtrière, Département des maladies du système nerveux, F-75013, Paris, France
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital of Terni, Terni, Italy
| | - Richard Dodel
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
| | - Murray Grossman
- Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Pennsylvania, USA
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Stefan Lorenzl
- Department of Palliative Medicine, Munich University Hospital, Ludwig-Maximilians-Universität (LMU), Munich, Munich, Germany
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
| | - Huw Morris
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
| | - Peter Nestor
- German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | | | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - James B Rowe
- Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Thilo van Eimeren
- Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
| | - Gregor K Wenning
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Adam Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - Lawrence I Golbe
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Irene Litvan
- Department of Neurology, University of California, San Diego, California, USA
| | - Maria Stamelou
- Department of Neurology, Philipps Universität, Marburg, Germany
- Second Department of Neurology, Attikon University Hospital, University of Athens, Greece
- HYGEIA Hospital, Athens, Greece
| | - Günter U Höglinger
- Department of Neurology, Technische Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases, Munich, Germany
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Hoglinger GU, Respondek G, Stamelou M, Kurz C, Josephs KA, Lang AE, Mollenhauer B, Muller U, Nilsson C, Whitwell JL, Arzberger T, Englund E, Gelpi E, Giese A, Irwin DJ, Meissner WG, Pantelyat A, Rajput A, van Swieten JC, Troakes C, Antonini A, Bhatia KP, Bordelon Y, Compta Y, Corvol JC, Colosimo C, Dickson DW, Dodel R, Ferguson L, Grossman M, Kassubek J, Krismer F, Levin J, Lorenzl S, Morris HR, Nestor P, Oertel WH, Poewe W, Rabinovici G, Rowe JB, Schellenberg GD, Seppi K, van Eimeren T, Wenning GK, Boxer AL, Golbe LI, Litvan I. Clinical diagnosis of progressive supranuclear palsy: The movement disorder society criteria. Mov Disord 2017; 32:853-864. [PMID: 28467028 PMCID: PMC5516529 DOI: 10.1002/mds.26987] [Citation(s) in RCA: 1285] [Impact Index Per Article: 183.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND PSP is a neuropathologically defined disease entity. Clinical diagnostic criteria, published in 1996 by the National Institute of Neurological Disorders and Stroke/Society for PSP, have excellent specificity, but their sensitivity is limited for variant PSP syndromes with presentations other than Richardson's syndrome. OBJECTIVE We aimed to provide an evidence- and consensus-based revision of the clinical diagnostic criteria for PSP. METHODS We searched the PubMed, Cochrane, Medline, and PSYCInfo databases for articles published in English since 1996, using postmortem diagnosis or highly specific clinical criteria as the diagnostic standard. Second, we generated retrospective standardized clinical data from patients with autopsy-confirmed PSP and control diseases. On this basis, diagnostic criteria were drafted, optimized in two modified Delphi evaluations, submitted to structured discussions with consensus procedures during a 2-day meeting, and refined in three further Delphi rounds. RESULTS Defined clinical, imaging, laboratory, and genetic findings serve as mandatory basic features, mandatory exclusion criteria, or context-dependent exclusion criteria. We identified four functional domains (ocular motor dysfunction, postural instability, akinesia, and cognitive dysfunction) as clinical predictors of PSP. Within each of these domains, we propose three clinical features that contribute different levels of diagnostic certainty. Specific combinations of these features define the diagnostic criteria, stratified by three degrees of diagnostic certainty (probable PSP, possible PSP, and suggestive of PSP). Clinical clues and imaging findings represent supportive features. CONCLUSIONS Here, we present new criteria aimed to optimize early, sensitive, and specific clinical diagnosis of PSP on the basis of currently available evidence. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gunter U. Hoglinger
- Department of Neurology, Technische Universitat Munchen, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Gesine Respondek
- Department of Neurology, Technische Universitat Munchen, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Maria Stamelou
- Second Department of Neurology, Attikon University Hospital, University of Athens, Athens, Greece
| | - Carolin Kurz
- Department of Psychiatry, Ludwig-Maximilians-Universitat, Munich, Germany
| | | | - Anthony E. Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, Toronto, Canada
| | - Brit Mollenhauer
- Paracelsus-Elena Klinik, Kassel, Germany, and University Medical Center Gottingen, Institute of Neuropathology, Gottingen, Germany
| | | | - Christer Nilsson
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | | | - Thomas Arzberger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Psychiatry, Ludwig-Maximilians-Universitat, Munich, Germany
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universitat, Munich, Germany
| | - Elisabet Englund
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Ellen Gelpi
- Neurological Tissue Bank of the Biobank - Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Armin Giese
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universitat, Munich, Germany
| | - David J. Irwin
- Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wassilios G. Meissner
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | | | - Alex Rajput
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Claire Troakes
- London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, and Department of Neurosciences, Padova University, Padova, Italy
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Yaroslau Compta
- Parkinson’s Disease & Movement Disorders Unit, Neurology Service, Hospital Clinic/IDIBAPS/University of Barcelona, Barcelona, Catalonia, Spain
| | - Jean-Christophe Corvol
- Sorbonne Universités, UPMC Univ Paris 06; and INSERM UMRS_1127, CIC_1422; and CNRS UMR_7225; and AP-HP; and ICM, Hôpital Pitié-Salpêtrière, Département des maladies du système nerveux, Paris, France
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital of Terni, Terni, Italy
| | | | - Richard Dodel
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
| | - Leslie Ferguson
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Murray Grossman
- Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Johannes Levin
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Neurology, Ludwig-Maximilians-Universitat, Munich, Germany
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Munich, Germany
| | - Huw R. Morris
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Peter Nestor
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | | | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Gil Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - James B. Rowe
- Department of Clinical Neurosciences, Cambridge University, Cambridge, United Kingdom
| | - Gerard D. Schellenberg
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Thilo van Eimeren
- Departments of Nuclear Medicine and Neurology, University of Cologne, Cologne, Germany
| | - Gregor K. Wenning
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - Lawrence I. Golbe
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Irene Litvan
- Department of Neurology, University of California, San Diego, California, USA
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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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Incipient progressive supranuclear palsy is more common than expected and may comprise clinicopathological subtypes: a forensic autopsy series. Acta Neuropathol 2017; 133:809-823. [PMID: 28064358 DOI: 10.1007/s00401-016-1665-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/30/2016] [Accepted: 12/30/2016] [Indexed: 12/14/2022]
Abstract
We investigated 998 serial Japanese forensic autopsy cases (0-101 years old, mean age 61.7 ± 21.9), with no case selection, using immunohistochemistry to detect cases with progressive supranuclear palsy (PSP). Twenty-nine cases (mean age 82.3 ± 7.2 years, 11 males, 18 females) fulfilled the National Institute of Neuronal Disorders and Stroke (NINDS)-PSP pathological criteria (2.9% of all cases, 4.6% of cases over 60). All had neuronal and glial inclusions in the basal ganglia and brainstem. However, 13 cases had low tau pathology and were categorized as atypical PSP. In addition to PSP pathology, multiple types of astrocytic inclusions and comorbid proteinopathies, particularly a high prevalence of argyrophilic grain disease, were found. All cases had not been diagnosed with PSP and had preserved daily functioning prior to death. However, 14 (48.3%), 11 (37.9%), and 16 (55.2%) cases showed signs of dementia, depressive state, and gait disturbance, respectively. Sixteen accidental death cases (55.2%), including from falls and getting lost, and 11 suicide cases (37.9%) appear to have a relationship with incipient PSP pathology. Cluster analysis using the distribution and amount of 4-repeat-tau pathology classified the cases into three subgroups: Group 1 (10 cases) had typical PSP pathology and seven cases (70.0%) had dementia as the most frequent symptom; Group 2 (7 cases) had significantly higher frequency of gait disorder (6 cases, 85.7%), and less neocortical tau pathology than Group 1; Group 3 (12 cases) had relatively mild PSP pathology and high argyrophilic grain burdens. Granular-shaped astrocytes were the dominant astrocytic inclusion in all cases. We conclude that in forensic cases incipient PSP occurs with a higher prevalence than expected. If these findings can be extrapolated to other population-based cohorts, PSP may be more common than previously thought.
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Abstract
Frontotemporal dementia (FTD) is a heterogeneous disorder with distinct clinical phenotypes associated with multiple neuropathologic entities. Presently, the term FTD encompasses clinical disorders that include changes in behavior, language, executive control, and often motor symptoms. The core FTD spectrum disorders include behavioral variant FTD, nonfluent/agrammatic variant primary progressive aphasia, and semantic variant PPA. Related FTD disorders include frontotemporal dementia with motor neuron disease, progressive supranuclear palsy syndrome, and corticobasal syndrome. In this article, the authors discuss the clinical presentation, diagnostic criteria, neuropathology, genetics, and treatments of these disorders.
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Affiliation(s)
- Nicholas T Olney
- Department of Neurology, UCSF Memory and Aging Center, San Francisco, CA, USA.
| | - Salvatore Spina
- Department of Neurology, UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Bruce L Miller
- Department of Neurology, UCSF Memory and Aging Center, San Francisco, CA, USA; UCSF School of Medicine, San Francisco, CA, USA
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Glasmacher SA, Leigh PN, Saha RA. Predictors of survival in progressive supranuclear palsy and multiple system atrophy: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2017; 88:402-411. [PMID: 28250027 DOI: 10.1136/jnnp-2016-314956] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/27/2016] [Accepted: 01/08/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To undertake a systematic review and meta-analysis of studies that investigated prognostic factors and survival in patients with progressive supranuclear palsy (PSP) and multiple system atrophy (MSA). METHODS Publications of at least 10 patients with a likely or confirmed diagnosis of PSP or MSA were eligible for inclusion. Methodological quality was rated using a modified version of the Quality in Prognostic Studies tool. For frequently examined prognostic factors, HRs derived by univariate and multivariate analysis were pooled in separate subgroups; other results were synthesised narratively and HRs could not be reported here. RESULTS Thirty-seven studies presenting findings on 6193 patients (1911 PSP, 4282 MSA) fulfilled the inclusion criteria. We identified the following variables as unfavourable predictors of survival. In PSP, PSP-Richardson's phenotype (univariate HR 2.53; 95% CI 1.69 to 3.78), early dysphagia and early cognitive symptoms. In MSA, severe dysautonomia and early development of combined autonomic and motor features but not MSA phenotype (multivariate HR 1.22; 95% CI 0.83 to 1.80).In PSP and MSA, survival was predicted by early falls (multivariate HR 2.32; 95% CI 1.94 to 2.77), the Neuroprotection and Natural History in Parkinson Plus Syndromes Parkinson Plus Score and the Clinical Global Impression Disease Severity Score but not sex (multivariate HR 0.93; 95% CI 0.67 to 1.28). There was conflicting evidence regarding the prognostic effect of age at onset and stridor. CONCLUSION Several clinical variables were strongly associated with shorter survival in PSP and MSA. Results on most prognostic factors were consistent across methodologically diverse studies; however, the lack of commonality of prognostic factors investigated is a significant limitation.
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Affiliation(s)
| | - Peter Nigel Leigh
- Department of Clinical Neuroscience, Brighton and Sussex Medical School, Brighton, UK
| | - Romi Anirban Saha
- Hurstwood Park Neurological Centre, Brighton and Sussex University Hospitals, Brighton, UK
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60
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Chiu WZ, Donker Kaat L, Boon AJW, Kamphorst W, Schleicher A, Zilles K, van Swieten JC, Palomero-Gallagher N. Multireceptor fingerprints in progressive supranuclear palsy. ALZHEIMERS RESEARCH & THERAPY 2017; 9:28. [PMID: 28412965 PMCID: PMC5393015 DOI: 10.1186/s13195-017-0259-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/24/2017] [Indexed: 05/29/2023]
Abstract
Background Progressive supranuclear palsy (PSP) with a frontal presentation, characterized by cognitive deficits and behavioral changes, has been recognized as an early clinical picture, distinct from the classical so-called Richardson and parkinsonism presentations. The midcingulate cortex is associated with executive and attention tasks and has consistently been found to be impaired in imaging studies of patients with PSP. The aim of the present study was to determine alterations in neurotransmission underlying the pathophysiology of PSP, as well as their significance for clinically identifiable PSP subgroups. Methods In vitro receptor autoradiography was used to quantify densities of 20 different receptors in the caudate nucleus and midcingulate area 24' of patients with PSP (n = 16) and age- and sex-matched control subjects (n = 14). Results Densities of γ-aminobutyric acid type B, peripheral benzodiazepine, serotonin receptor type 2, and N-methyl-d-aspartate receptors were significantly higher in area 24′ of patients with PSP, where tau impairment was stronger than in the caudate nucleus. Kainate and nicotinic cholinergic receptor densities were significantly lower, and adenosine receptor type 1 (A1) receptors significantly higher, in the caudate nucleus of patients with PSP. Receptor fingerprints also segregated PSP subgroups when clinical parameters such as occurrence of frontal presentation and tau pathology severity were taken into consideration. Conclusions We demonstrate, for the first time to our knowledge, that kainate and A1 receptors are altered in PSP and that clinically identifiable PSP subgroups differ at the neurochemical level. Numerous receptors were altered in the midcingulate cortex, further suggesting that it may prove to be a key region in PSP. Finally, we add to the evidence that nondopaminergic systems play a role in the pathophysiology of PSP, thus highlighting potential novel treatment strategies.
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Affiliation(s)
- Wang Zheng Chiu
- Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Laura Donker Kaat
- Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Agnita J W Boon
- Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Wouter Kamphorst
- Department of Neuropathology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
| | - Axel Schleicher
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
| | - Karl Zilles
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany.,Jülich Aachen Research Alliance (JARA), Translational Brain Medicine, Aachen, Germany
| | - John C van Swieten
- Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Nicola Palomero-Gallagher
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany. .,Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany.
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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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Santillo AF, Lundblad K, Nilsson M, Landqvist Waldö M, van Westen D, Lätt J, Blennow Nordström E, Vestberg S, Lindberg O, Nilsson C. Grey and White Matter Clinico-Anatomical Correlates of Disinhibition in Neurodegenerative Disease. PLoS One 2016; 11:e0164122. [PMID: 27723823 PMCID: PMC5056728 DOI: 10.1371/journal.pone.0164122] [Citation(s) in RCA: 13] [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: 02/02/2016] [Accepted: 09/20/2016] [Indexed: 11/30/2022] Open
Abstract
Disinhibition is an important symptom in neurodegenerative diseases. However, the clinico-anatomical underpinnings remain controversial. We explored the anatomical correlates of disinhibition in neurodegenerative disease using the perspective of grey and white matter imaging. Disinhibition was assessed with a neuropsychological test and a caregiver information-based clinical rating scale in 21 patients with prefrontal syndromes due to behavioural variant frontotemporal dementia (n = 12) or progressive supranuclear palsy (n = 9), and healthy controls (n = 25). Cortical thickness was assessed using the Freesurfer software on 3T MRI data. The integrity of selected white matter tracts was determined by the fractional anisotropy (FA) from Diffusion Tensor Imaging. Disinhibition correlated with the cortical thickness of the right parahippocampal gyrus, right orbitofrontal cortex and right insula and the FA of the right uncinate fasciculus and right anterior cingulum. Notably, no relationship was seen with the thickness of ventromedial prefrontal cortex. Our results support an associative model of inhibitory control, distributed in a medial temporal lobe-insular-orbitofrontal network, connected by the intercommunicating white matter tracts. This reconciles some of the divergences among previous studies, but also questions the current conceptualisation of the “prefrontal” syndrome and the central role attributed to the ventromedial prefrontal cortex in inhibitory control.
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Affiliation(s)
| | - Karl Lundblad
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Markus Nilsson
- Lund University Bioimaging Centre (LBIC), Lund University, Lund, Sweden
| | - Maria Landqvist Waldö
- Geriatric Psychiatry Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Danielle van Westen
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Jimmy Lätt
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Erik Blennow Nordström
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Susanna Vestberg
- Geriatric Psychiatry Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Psychology, Lund University, Lund, Sweden
| | - Olof Lindberg
- Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
| | - Christer Nilsson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
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Krudop WA, Dols A, Kerssens CJ, Prins ND, Möller C, Schouws S, Barkhof F, van Berckel BNM, Teunissen CE, van der Flier WM, Scheltens P, Sikkes SAM, Stek ML, Pijnenburg YAL. Impact of Imaging and Cerebrospinal Fluid Biomarkers on Behavioral Variant Frontotemporal Dementia Diagnosis within a Late-Onset Frontal Lobe Syndrome Cohort. Dement Geriatr Cogn Disord 2016; 41:16-26. [PMID: 26473985 DOI: 10.1159/000441023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The criteria for behavioral variant frontotemporal dementia (bvFTD) incorporate MRI and [18F]-FDG-PET. Cerebrospinal fluid (CSF) analysis is merely advised for excluding Alzheimer's disease. AIMS We aimed to assess the impact of biomarkers on diagnostic certainty and contingent changes of bvFTD diagnosis within the clinically relevant neuropsychiatric differential diagnosis of subjects with a late-onset frontal lobe syndrome (LOF). METHODS We included 137 patients with LOF, aged 45-75 years, 72% males. Biomarker disclosure was considered contributing after any substantial difference in diagnostic certainty or a diagnostic change. Percentages of contributing biomarkers were compared between three major diagnostic groups (bvFTD, psychiatry, other neurological disorders). Certainty levels in stable diagnostic groups were compared to those with a diagnostic change. RESULTS Biomarkers contributed in 53, 60 and 41% of the LOF patients for MRI, [18F]-FDG-PET and CSF, respectively. Biomarkers changed the diagnosis in 14% of cases towards bvFTD and in 13% from bvFTD into an alternative. Those that changed had a lower level of a priori diagnostic certainty compared to stable diagnoses. CONCLUSION Our study not only supports the widely accepted use of MRI and [18F]-FDG-PET in diagnosing or excluding bvFTD, but also shows that CSF biomarkers aid clinicians in the diagnostic process.
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Affiliation(s)
- Welmoed A Krudop
- Alzheimer Center, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Hwang M, Yang H, Kim Y, Youn J, Park J, Huh YE, Kim HT, Cho JW. Differential Progression of Midbrain Atrophy in Parkinsonism: Longitudinal MRI Study. NEURODEGENER DIS 2016; 17:31-37. [PMID: 27614955 DOI: 10.1159/000448174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/04/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS To elucidate different patterns of progression of midbrain atrophy in patients with Richardson's syndrome (RS), progressive supranuclear palsy-parkinsonism (PSP-P), and Parkinson's disease (PD) using magnetic resonance imaging (MRI)-based visual rating indexes. METHODS We recruited 12 patients with PSP-RS, 12 with PSP-P, and 23 with PD for whom MRIs had been followed up for at least 2 years (mean ± SD, 4.9 ± 1.6 years) after the initial MRI. MRI-based visual rating indexes were used to estimate midbrain atrophy, including the ratio of the pontine to midbrain tegmental areas (P/M ratio) on a midsagittal image, the length between the interpeduncular fossa and the center of the cerebral aqueduct at the midmammillary-body level (MTEGM) on axial images, and the morning glory sign. RESULTS Initially, there were no differences in MRI-based visual rating indexes between PSP-P and PD, while PSP-RS showed a higher P/M ratio and lower MTEGM compared with PSP-P and PD. In PD, the P/M ratio and MTEGM remained stable with disease progression. However, the extent of changes between initial and follow-up indexes was similarly greater for both PSP-RS and PSP-P than for PD. Finally, PSP-P showed a higher P/M ratio and lower MTEGM compared with PD in the follow-up, while PSP-RS still exhibited the most profound changes. CONCLUSIONS Midbrain atrophy progresses differentially in patients with PSP-RS, PSP-P, and PD. Longitudinal measurements of midbrain atrophy using MRI-based visual rating indexes can help distinguish patients with PSP-P from those with PSP-RS and PD.
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Affiliation(s)
- Minho Hwang
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Progressive supranuclear palsy and corticobasal degeneration: Diagnostic challenges and clinicopathological considerations. Rev Neurol (Paris) 2016; 172:488-502. [DOI: 10.1016/j.neurol.2016.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/04/2016] [Accepted: 07/12/2016] [Indexed: 11/22/2022]
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Nicoletti A, Luca A, Luca M, Donzuso G, Mostile G, Raciti L, Contrafatto D, Dibilio V, Sciacca G, Cicero CE, Vasta R, Petralia A, Zappia M. Obsessive compulsive personality disorder in Progressive Supranuclear Palsy, Multiple System Atrophy and Essential Tremor. Parkinsonism Relat Disord 2016; 30:36-9. [PMID: 27364040 DOI: 10.1016/j.parkreldis.2016.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 05/27/2016] [Accepted: 06/19/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION aim of the study was to evaluate the presence of the Obsessive Compulsive Personality Disorder (OCPeD) in Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP) and Essential Tremor (ET) and in a group of healthy subjects. METHODS patients affected by MSA, PSP and ET diagnosed according to currently accepted diagnostic criteria and a group of healthy controls were enrolled in the study. Patients with cognitive impairment were excluded from the study. The Structured Clinical Interview for Personality Disorders-II (SCID-II) has been performed to evaluate the presence of personality disorders (PeDs). The diagnosis of OCPeD was confirmed by a psychiatric interview. RESULTS fifteen MSA patients (8 men and 7 women; aged 62.9 ± 7.6 years), 14 PSP patients (8 men and 6 women; aged 69.8 ± 4.4 years), 16 ET patients (10 men and 6 women; aged 70.4 ± 6.4 years) and 20 healthy subjects (10 men and 10 women; aged 65.5 ± 6.0 years) were enrolled. OCPeD was recorded in 5 (35.7%) PSP patients, 2 (13.3%) MSA patients, 2 (12.5%) ET patient and 2 (10%) controls. CONCLUSION a low frequency of OCPeD, close to those recorded in healthy subjects, was recorded in both MSA and ET patients. Conversely an higher frequency of OCPeD, similar to PD was found among PSP patients, supporting the possibility of an impairment of common basal ganglia network possibly involving the orbito-frontal circuits.
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Affiliation(s)
- A Nicoletti
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy
| | - A Luca
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy
| | - M Luca
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - G Donzuso
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy
| | - G Mostile
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy
| | - L Raciti
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy
| | - D Contrafatto
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy
| | - V Dibilio
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy
| | - G Sciacca
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy
| | - C E Cicero
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy
| | - R Vasta
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy
| | - A Petralia
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - M Zappia
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy.
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Garrido A, Vilas D, Tolosa E. Update on the Diagnosis and Management of Progressive Supranuclear Palsy. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yamamoto T, Tateno F, Sakakibara R, Furukawa S, Asahina M, Uchiyama T, Hirano S, Yamanaka Y, Fuse M, Koga Y, Yanagisawa M, Kuwabara S. Urinary Dysfunction in Progressive Supranuclear Palsy Compared with Other Parkinsonian Disorders. PLoS One 2016; 11:e0149278. [PMID: 26886104 PMCID: PMC4757534 DOI: 10.1371/journal.pone.0149278] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/30/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Autonomic urinary dysfunction affects patients with progressive supranuclear palsy (PSP); however, the severity and prevalence of urinary dysfunctions in these patients compared with those observed in patients with Parkinson's disease (PD) and multiple system atrophy (MSA) are unknown. OBJECTIVE We compared urinary dysfunction characteristics in patients with PSP, PD, and MSA. PATIENTS AND METHODS Forty-seven patients who satisfied the probable or possible criteria of the National Institute for Neurological Diseases and Stroke and Society for PSP were assessed using the urinary symptoms questionnaire and the urodynamic study at Chiba and Toho Universities (n = 26 and 21, respectively). The results were compared with those of patients with PD and MSA (n = 218 and 193, respectively). RESULTS The mean disease duration of PSP and the mean age were 2.97 ± 0.26 and 71.4 ± 0.88 years, respectively. The mini-mental state examination and frontal assessment battery scores were 22.6 ± 0.70 and 10.7 ± 0.49, respectively. Urinary storage and voiding symptoms were observed in 57% and 56% of patients with PSP, respectively. Detrusor overactivity in the urodynamic study was detected in 81% of patients with PSP, which was slightly more than that found in patients with PD (69%) and MSA (67%); however, this was not statistically significant. Postvoid residual volume in patients with PSP was significantly more than that in patients with PD (P < 0.01), but was equivalent to that in patients with MSA. CONCLUSIONS The present study demonstrated that patients with PSP experienced various urinary dysfunctions. Urinary storage dysfunction in patients with PSP was not different from that in patients with PD or MSA, whereas urinary voiding dysfunction in patients with PSP was milder than that in patients with MSA and more severe than that in patients with PD. These features should be taken into account for the differentiation of PSP from PD and MSA.
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Affiliation(s)
- Tatsuya Yamamoto
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Fuyuki Tateno
- Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Ryuji Sakakibara
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
- Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Shogo Furukawa
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masato Asahina
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomoyuki Uchiyama
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Neurology, Continence Center, Dokkyo Medical University, Tochigi, Japan
| | - Shigeki Hirano
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshitaka Yamanaka
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Miki Fuse
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasuko Koga
- Department of Molecular Diagnosis, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mitsuru Yanagisawa
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan
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Krudop WA, Bosman S, Geurts JJG, Sikkes SAM, Verwey NA, Stek ML, Scheltens P, Rozemuller AJM, Pijnenburg YAL. Clinico-Pathological Correlations of the Frontal Lobe Syndrome: Results of a Large Brain Bank Study. Dement Geriatr Cogn Disord 2016; 40:121-9. [PMID: 26088035 DOI: 10.1159/000430460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 11/19/2022] Open
Abstract
AIMS A clinical frontal lobe syndrome (FLS) is generally attributed to functional or structural disturbances within frontal-subcortical circuits. We studied the distribution of pathological brain changes in FLS. Additionally, the prevalence of FLS among various disorders was studied. METHODS We systematically screened clinical files of donors to the Netherlands Brain Bank (n = 2,814) for FLS. A total of 262 FLS cases were identified, and the distribution of postmortem pathological changes within the frontal-subcortical circuits was extracted from their neuropathological reports. RESULTS In 244 out of 262 patients (93%), pathological changes within the frontal-subcortical circuits were found: 90 subjects (34%) with frontal cortical pathology and 18 (7%) with pathology restricted to subcortical grey matter nuclei, whereas 136 subjects (52%) showed both cortical and subcortical pathology. In 18 subjects (7%), no pathology was found in the examined areas. The prevalence of FLS was highest in frontal-temporal lobar degeneration, followed by progressive supranuclear palsy and vascular dementia [χ(2)(6, n = 1,561) = 222.64, p < 0.01]. CONCLUSION In this large brain bank study, the distribution of pathological changes in subjects with FLS was shown to be frontal-subcortical for the first time. A minority of FLS cases had pathology in the subcortical regions only or no frontal pathology at all.
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Affiliation(s)
- Welmoed A Krudop
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Krudop WA, Kerssens CJ, Dols A, Prins ND, Möller C, Schouws S, van der Flier WM, Scheltens P, Sikkes S, Stek ML, Pijnenburg YAL. Identifying bvFTD Within the Wide Spectrum of Late Onset Frontal Lobe Syndrome: A Clinical Approach. Am J Geriatr Psychiatry 2015; 23:1056-66. [PMID: 25921226 DOI: 10.1016/j.jagp.2015.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The behavioral variant of frontotemporal dementia (bvFTD) can be difficult to diagnose because of the extensive differential diagnosis, including many other diseases presenting with a frontal lobe syndrome. We aimed to identify the diagnostic spectrum causing a late onset frontal lobe syndrome and examine the quality of commonly used instruments to distinguish between bvFTD and non-bvFTD patients, within this syndrome. METHODS A total of 137 patients fulfilling the criteria of late onset frontal lobe syndrome, aged 45 to 75 years, were included in a prospective observational study. Diagnoses were made after clinical and neuropsychological examination, and neuroimaging and cerebral spinal fluid results were taken into account. Baseline characteristics and the scores on the Mini-Mental State Exam (MMSE), frontal assessment battery (FAB), Frontal Behavioral Inventory (FBI), and Stereotypy Rating Inventory (SRI) were compared between the bvFTD and the non-bvFTD group. RESULTS Fifty-five (40%) of the patients received a bvFTD diagnosis (33% probable and 7% possible bvFTD). Fifty-one patients (37%) had a psychiatric disorder, including 20 with major depressive disorder. Thirty-one patients received an alternative neurological, including neurodegenerative, diagnosis. MMSE and FAB scores were unspecific for a particular diagnosis. A score above 12 on the positive FBI subscale or a score above 5 on the SRI were indicative of a bvFTD diagnosis. CONCLUSION A broad spectrum of both neurological and psychiatric disorders underlies late onset frontal lobe syndrome, of which bvFTD was the most prevalent diagnosis in our cohort. The commonly used MMSE and the FAB could not successfully distinguish between bvFTD and non-bvFTD, but this could be achieved with the more specific FBI and SRI.
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Affiliation(s)
- Welmoed A Krudop
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands.
| | - Cora J Kerssens
- Department of Old Age Psychiatry, GGZInGeest, Amsterdam, the Netherlands
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZInGeest, Amsterdam, the Netherlands
| | - Niels D Prins
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands
| | - Christiane Möller
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands
| | - Sigfried Schouws
- Department of Old Age Psychiatry, GGZInGeest, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands
| | - Sietske Sikkes
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Max L Stek
- Department of Old Age Psychiatry, GGZInGeest, Amsterdam, the Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Center and Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands
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Respondek G, Höglinger GU. The phenotypic spectrum of progressive supranuclear palsy. Parkinsonism Relat Disord 2015; 22 Suppl 1:S34-6. [PMID: 26421392 DOI: 10.1016/j.parkreldis.2015.09.041] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/19/2015] [Indexed: 12/11/2022]
Abstract
Traditionally, the clinical picture of progressive supranuclear palsy (PSP) was defined by early postural instability with falls, supranuclear vertical gaze palsy, symmetric akinesia and rigidity, frontal and subcortical dementia, and pseudobulbar palsy, leading to death after a mean disease duration of approximately six years. A definite diagnosis of PSP depends on neuropathological confirmation. In recent years, clinico-pathological studies have drawn attention to various "atypical" clinical manifestations of PSP. In these, a clinical diagnosis of PSP is delayed or never accomplished. Comprehensive understanding of the natural history of PSP is required to permit an early and accurate diagnosis. Based on current evidence, this review provides an update on the clinical spectrum of PSP.
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Affiliation(s)
- G Respondek
- Department of Neurology, Klinikum Rechts der Isar, Technical University, Ismaninger Strasse 22, D-81675, Munich, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen [DZNE], Site Munich, Feodor-Lynen Str. 17, D-81677, Munich, Germany
| | - G U Höglinger
- Department of Neurology, Klinikum Rechts der Isar, Technical University, Ismaninger Strasse 22, D-81675, Munich, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen [DZNE], Site Munich, Feodor-Lynen Str. 17, D-81677, Munich, Germany.
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Stamelou M, Diehl-Schmid J, Hapfelmeier A, Kontaxopoulou D, Stefanis L, Oertel WH, Bhatia KP, Papageorgiou SG, Höglinger GU. The frontal assessment battery is not useful to discriminate progressive supranuclear palsy from frontotemporal dementias. Parkinsonism Relat Disord 2015; 21:1264-8. [PMID: 26324212 DOI: 10.1016/j.parkreldis.2015.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 07/08/2015] [Accepted: 08/07/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The frontal assessment battery (FAB) has been suggested as a useful tool in the differential diagnosis of progressive supranuclear palsy (PSP) from Parkinson's disease (PD) and multiple system atrophy with parkinsonism (MSA-P). However, the utility of the FAB in the differential diagnosis of PSP from frontotemporal dementia (FTD) phenotypes is still under research. METHODS We performed the FAB, in a multi-centre cohort of 70 PSP, 103 FTD (N = 84 behavioral variant FTD, N = 10 semantic dementia, N = 9 progressive non-fluent aphasia), 26 PD and 11 MSA-P patients, diagnosed according to established criteria. Patients were also rated with the mini mental state examination and motor scales. RESULTS The FAB total score showed a poor discriminatory power between PSP and FTD as a group [area under the curve (AUC) = 0.523]. Moreover, the FAB score showed no correlation with disease duration in PSP (r = 0.05) or FTD group (r = 0.04). In contrast, we confirmed that the FAB is clinically useful to differentiate PSP from PD and MSA-P (AUC = 0.927). In fact, the sum of two FAB subscores together (verbal fluency and Luria motor series) were as good as the total score in differentiating PSP from PD and MSA-P (AUC = 0.957). CONCLUSIONS The FAB may not be a useful tool to differentiate PSP from FTDs, and shows no correlation with disease duration in these disorders. On the other hand, the essential information to differentiate PSP from PD and MSA-P is contained in the sum of only two FAB subscores. This should be taken into consideration in both clinical practice and the planning of clinical trials.
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Affiliation(s)
- M Stamelou
- Department of Neurology, Philipps Universität, Marburg, Germany; Second Department of Neurology, Attikon University Hospital, University of Athens, Greece; Movement Disorders Department, Hygeia Hospital, Athens, Greece.
| | - J Diehl-Schmid
- Department of Psychiatry, Technische Universität München, Munich, Germany
| | - A Hapfelmeier
- Department of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - D Kontaxopoulou
- Second Department of Neurology, Attikon University Hospital, University of Athens, Greece
| | - L Stefanis
- Second Department of Neurology, Attikon University Hospital, University of Athens, Greece
| | - W H Oertel
- Department of Neurology, Philipps Universität, Marburg, Germany
| | - K P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - S G Papageorgiou
- Second Department of Neurology, Attikon University Hospital, University of Athens, Greece; First Department of Neurology, Eginition University General Hospital, University of Athens, Greece
| | - G U Höglinger
- Department of Neurology, Philipps Universität, Marburg, Germany; Department of Neurology, Technische Universität München, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), München, Germany
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Lashley T, Rohrer JD, Mead S, Revesz T. Review: An update on clinical, genetic and pathological aspects of frontotemporal lobar degenerations. Neuropathol Appl Neurobiol 2015; 41:858-81. [DOI: 10.1111/nan.12250] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/27/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Tammaryn Lashley
- Queen Square Brain Bank for Neurological Disorders; Department of Molecular Neuroscience; UCL Institute of Neurology; London UK
| | | | - Simon Mead
- Department of Neurodegenerative Disease; UCL Institute of Neurology; London UK
| | - Tamas Revesz
- Queen Square Brain Bank for Neurological Disorders; Department of Molecular Neuroscience; UCL Institute of Neurology; London UK
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74
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Kim JH, McCann CM. Communication impairments in people with progressive supranuclear palsy: A tutorial. JOURNAL OF COMMUNICATION DISORDERS 2015; 56:76-87. [PMID: 26184056 DOI: 10.1016/j.jcomdis.2015.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 06/06/2015] [Accepted: 06/29/2015] [Indexed: 06/04/2023]
Abstract
Progressive supranuclear palsy (PSP) is a progressive neurological condition, whose main features include supranuclear gaze palsy, frequent falls, bradykinesia, axial rigidity, cognitive decline and communication impairments. Even though communication impairments are early and prominent manifestations, there is a significant lack of research on the nature of these impairments in PSP and the role of speech-language pathologists (SLPs). This tutorial article aims to describe the communication impairments observed in people with PSP; provide clinical guidelines for SLPs when assessing motor speech, language and other communication impairments; and to present facilitation and compensation approaches to treatment for people with PSP. The predominant motor speech impairment is mixed dysarthria, but there is a lack of consensus about the classification of language impairments. The involvement of SLPs in the assessment and treatment of people with PSP should be early, on-going and in collaboration with other health professionals, with the primary focus of maintaining quality of life for these patients and their family members.
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Affiliation(s)
- Jae-Hyun Kim
- College of Healthcare Sciences, James Cook University, New Zealand; School of Psychology, The University of Auckland, New Zealand.
| | - Clare M McCann
- School of Psychology, The University of Auckland, New Zealand; Centre for Brain Research, The University of Auckland, New Zealand
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Yokoyama Y, Toyoshima Y, Shiga A, Tada M, Kitamura H, Hasegawa K, Onodera O, Ikeuchi T, Someya T, Nishizawa M, Kakita A, Takahashi H. Pathological and Clinical Spectrum of Progressive Supranuclear Palsy: With Special Reference to Astrocytic Tau Pathology. Brain Pathol 2015; 26:155-66. [PMID: 25974705 DOI: 10.1111/bpa.12265] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/23/2015] [Indexed: 01/07/2023] Open
Abstract
Progressive supranuclear palsy (PSP) is a four-repeat tauopathy with tau-positive, argyrophilic tuft-shaped astrocytes (TAs). We performed a pathological and clinical investigation in 40 consecutive autopsied Japanese patients with pathological diagnoses of PSP or PSP-like disease. Unequivocal TAs were present in 22 cases, all of which were confirmed to be PSP. Such TAs were hardly detected in the other 18 cases, which instead exhibited tau-positive, argyrophilic astrocytes, appearing as comparatively small clusters with central nuclei of irregularly shaped, coarse structures (equivocal TAs). Cluster analysis of the distribution pattern of tau-related pathology for these 18 cases identified two subgroups, pallido-nigro-luysian atrophy (PNLA) Type 1 (n = 9) and Type 2 (n = 9), the former being distinguished from the latter by the presence of tau-related lesions in the motor cortex, pontine nucleus and cerebellar dentate nucleus in addition to the severely affected PNL system. The duration from symptom onset until becoming wheelchair-bound was significantly longer in PNLA Type 1. Immunoblotting of samples from the three disease conditions revealed band patterns of low-molecular-mass tau fragments at ∼35 kDa. These findings shed further light on the wide pathological and clinical spectrum of four-repeat tauopathy, representing PSP in the broad sense rather than classical PSP.
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Affiliation(s)
- Yuichi Yokoyama
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan.,Department of Psychiatry, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Yasuko Toyoshima
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Atsushi Shiga
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Mari Tada
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Hideaki Kitamura
- Department of Psychiatry, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Kazuko Hasegawa
- Department of Neurology, Sagamihara National Hospital, Sagamihara, Japan
| | - Osamu Onodera
- Department of Molecular Neuroscience, Brain Research Institute, Niigata University, Niigata, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Niigata, Japan
| | - Toshiyuki Someya
- Department of Psychiatry, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Masatoyo Nishizawa
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Hitoshi Takahashi
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
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Abstract
Frontotemporal dementia (FTD) is a heterogeneous group of hereditary and sporadic neurodegenerative disorders affecting frontotemporal areas. FTD, a leading cause of young-onset dementia, is often initially mistaken for primary psychiatric disorders. Based on early and predominant symptoms, different clinical syndromes can be distinguished: the behavioral variant and 2 variants of progressive aphasia; semantic dementia and progressive nonfluent aphasia. Neuropathological classification is based on protein accumulation in the brain. Pathogenic mutations in different genes have been identified. Specific pharmacological treatment is the main research goal. Meanwhile the management must focus on early correct diagnosis, symptom alleviation, caregiver support and educational interventions.
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Affiliation(s)
- Maria Landqvist Waldö
- Section of Geriatric Psychiatry, Department of Clinical Sciences, Lund University, Klinikgatan 22, Lund SE-221 85, Sweden.
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77
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Ravid R. The uniqueness of biobanks for neurological and psychiatric diseases: potentials and pitfalls. Pathobiology 2015; 81:237-244. [PMID: 25792212 DOI: 10.1159/000369886] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Central nervous system (CNS) biobanks are facing difficult and specific challenges due to the sensitive issue of collecting specimens of the CNS, and especially the brain. At present, there is no global network/central database to serve researchers, clinicians and pharma companies, or to supply the special specimens and the accompanying data in sufficient numbers and detail, respectively. The main challenge/objective is to standardize and harmonize all the facets involved in CNS biobanking in order to maximize efficient sample collection. METHODS Since the number of CNS biospecimens stored in existing biobanks is relatively limited and the accompanying data are not always readily available and hard to identify, we propose using optimal procedures for handling and storage of these specimens, and the global standardization of the cliniconeuropathological diagnostic criteria. RESULTS One of the prominent achievements of the current global activity in brain tissue biobanks (BTB-banks) is the development of an inventory of international standards, available specimens and concomitant data, and national registries. CONCLUSIONS Taking into consideration the huge variety of the specimens stored in different repositories and the enormous differences in medicolegal systems and ethics regulations in different countries, we strongly recommend that healthcare systems and institutions who host BTB-banks make efforts to secure adequate funding for the infrastructure and daily activities. BTB-banks will refine standard operating procedures and their internal guides of best practices/codes of conduct. This in turn will enable the BTB-banks to share the collected specimens and data with the largest possible number of researchers, aiming at maximal scientific spin-off and advance of public health research.
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Affiliation(s)
- Rivka Ravid
- BrainBank Consultants, Amsterdam, The Netherlands
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78
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Kobylecki C, Jones M, Thompson JC, Richardson AM, Neary D, Mann DMA, Snowden JS, Gerhard A. Cognitive-behavioural features of progressive supranuclear palsy syndrome overlap with frontotemporal dementia. J Neurol 2015; 262:916-22. [PMID: 25663411 DOI: 10.1007/s00415-015-7657-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/25/2015] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
Cognitive impairment is common in patients with the neurodegenerative tauopathy progressive supranuclear palsy (PSP). Although a pattern of 'subcortical' cognitive impairment is considered prototypical in PSP, pathological and clinical observations suggest an overlap with frontotemporal dementia (FTD). Our objective was to evaluate behavioural and cognitive symptoms in a retrospective study of patients with PSP syndrome (PSPS) and their relationship to features seen in behavioural variant FTD. We reviewed the records of 62 patients (29 male, 33 female, median age 65.5 years) evaluated at a tertiary cognitive clinic who met NINDS-SPSP criteria for probable or possible PSP, and collected clinical details of their presenting history, cognitive and behavioural features. We also evaluated the proportion of patients fulfilling FTD Consensus criteria. Cognitive and behavioural symptoms were a predominant presenting feature in 58% of patients evaluated. Cognitive slowing, executive impairments, and inefficient memory recall, consistent with 'subcortical' impairment, were identified in the majority of patients. Twenty patients (32%) fulfilled cognitive and behavioural criteria for possible FTD at initial assessment, whereas behavioural changes not meeting formal diagnostic criteria were present in a greater proportion of the patients. Our findings support the existence of a spectrum of cognitive-behavioural features in PSPS, with significant clinical overlap with behavioural variant FTD. Cognitive and behavioural profiling should be an integral part of the assessment of patients with PSPS.
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Affiliation(s)
- Christopher Kobylecki
- Cerebral Function Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK,
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79
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Respondek G, Stamelou M, Kurz C, Ferguson LW, Rajput A, Chiu WZ, van Swieten JC, Troakes C, Al Sarraj S, Gelpi E, Gaig C, Tolosa E, Oertel WH, Giese A, Roeber S, Arzberger T, Wagenpfeil S, Höglinger GU. The phenotypic spectrum of progressive supranuclear palsy: a retrospective multicenter study of 100 definite cases. Mov Disord 2014; 29:1758-66. [PMID: 25370486 DOI: 10.1002/mds.26054] [Citation(s) in RCA: 235] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/13/2014] [Accepted: 09/16/2014] [Indexed: 11/06/2022] Open
Abstract
The phenotypic variability of progressive supranuclear palsy (PSP) may account for its frequent misdiagnosis, in particular in early stages of the disease. However, large multicenter studies to define the frequency and natural history of PSP phenotypes are missing. In a cohort of 100 autopsy-confirmed patients we studied the phenotypic spectrum of PSP by retrospective chart review. Patients were derived from five brain banks with expertise in neurodegenerative disorders with referrals from multiple academic hospitals. The clinical characteristics of the 100 cases showed remarkable heterogeneity. Most strikingly, only 24% of cases presented as Richardson's Syndrome (RS), and more than half of the cases either showed overlapping features of several predescribed phenotypes, or features not fitting proposed classification criteria for PSP phenotypes. Classification of patients according to predominant clinical features in the first 2 years of the disease course allowed a more comprehensive description of the phenotypic spectrum. These predominance types differed significantly with regard to survival time and frequency of cognitive deficits. In summary, the phenotypic spectrum of PSP may be broader and more variable than previously described in single-center studies. Thus, too strict clinical criteria defining distinct phenotypes may not reflect this variability. A more pragmatic clinical approach using predominance types could potentially be more helpful in the early recognition of and for making prognostic predictions for these patients. Given the limitations arising from the retrospective nature of this analysis, a systematic validation in a prospective cohort study is imperative.
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Affiliation(s)
- Gesine Respondek
- Department of Neurology, Technische Universität München, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; Department of Neurology, Philipps Universität, Marburg, Germany
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Abstract
The basal ganglia were originally thought to be associated purely with motor control. However, dysfunction and pathology of different regions and circuits are now known to give rise to many clinical manifestations beyond the association of basal ganglia dysfunction with movement disorders. Moreover, disorders that were thought to be caused by dysfunction of the basal ganglia only, such as Parkinson's disease and Huntington's disease, have diverse abnormalities distributed not only in the brain but also in the peripheral and autonomic nervous systems; this knowledge poses new questions and challenges. We discuss advances and the unanswered questions, and ways in which progress might be made.
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Affiliation(s)
- Jose A Obeso
- Movement Disorders Laboratory, Department of Neurology and Neuroscience Area, Clínica Universitaria and Medical School, and CIMA, University of Navarra, Pamplona, Spain; Centro de Investigación en Redes sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
| | - Maria C Rodriguez-Oroz
- Centro de Investigación en Redes sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Neurology, University Hospital Donostia and Neuroscience Unit BioDonostia Research Institute, San Sebastian, Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Maria Stamelou
- Movement Disorders Clinic, Second Department of Neurology, Attiko Hospital, University of Athens, Greece; Sobell Department of Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Kailash P Bhatia
- Sobell Department of Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, UK
| | - David J Burn
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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81
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Tessitore A, Giordano A, Caiazzo G, Corbo D, De Micco R, Russo A, Liguori S, Cirillo M, Esposito F, Tedeschi G. Clinical correlations of microstructural changes in progressive supranuclear palsy. Neurobiol Aging 2014; 35:2404-10. [PMID: 24786632 DOI: 10.1016/j.neurobiolaging.2014.03.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 03/11/2014] [Accepted: 03/23/2014] [Indexed: 11/16/2022]
Abstract
In patients with progressive supranuclear palsy (PSP), previous reports have shown a severe white matter (WM) damage involving supra and infratentorial regions including cerebellum. In the present study, we investigated potential correlations between WM integrity loss and clinical-cognitive features of patients with PSP. By using magnetic resonance imaging and diffusion tensor imaging with tract based spatial statistic analysis, we analyzed WM volume in 18 patients with PSP and 18 healthy controls (HCs). All patients and HCs underwent a detailed clinical and neuropsychological evaluation. Relative to HCs, patients with PSP showed WM changes encompassing supra and infratentorial areas such as corpus callosum, fornix, midbrain, inferior fronto-occipital fasciculus, anterior thalamic radiation, superior cerebellar peduncle, superior longitudinal fasciculus, uncinate fasciculus, cingulate gyrus, and cortico-spinal tract bilaterally. Among different correlations between motor-cognitive features and WM structural abnormalities, we detected a significant association between fronto-cerebellar WM loss and executive cognitive impairment in patients with PSP. Our findings, therefore, corroborate the hypothesis that cognitive impairment in PSP may result from both "intrinsic" and "extrinsic" frontal lobe dysfunction, likely related to cerebellar disconnection.
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Affiliation(s)
| | - Alfonso Giordano
- Department of Neurology, Second University of Naples, Naples, Italy; IDC Hermitage Capodimonte, Naples, Italy
| | - Giuseppina Caiazzo
- MRI Research Center SUN-FISM, Second University of Naples, Naples, Italy
| | - Daniele Corbo
- MRI Research Center SUN-FISM, Second University of Naples, Naples, Italy
| | - Rosa De Micco
- Department of Neurology, Second University of Naples, Naples, Italy
| | - Antonio Russo
- Department of Neurology, Second University of Naples, Naples, Italy; IDC Hermitage Capodimonte, Naples, Italy
| | - Sara Liguori
- Department of Neurology, Second University of Naples, Naples, Italy
| | - Mario Cirillo
- Neuroradiology Service, Second University of Naples, Naples, Italy
| | - Fabrizio Esposito
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy; Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands
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82
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Bhidayasiri R, Jitkritsadakul O, Petchrutchatachart S, Kaewwilai L, Panyakaew P, Boonrod N, Colosimo C. Nocturnal manifestations of atypical and vascular parkinsonism: How do they differ from Parkinson’s disease? J Neural Transm (Vienna) 2014; 121 Suppl 1:S69-77. [DOI: 10.1007/s00702-014-1198-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 03/12/2014] [Indexed: 12/13/2022]
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83
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Lagarde J, Valabrègue R, Corvol JC, Pineau F, Le Ber I, Vidailhet M, Dubois B, Levy R. Are frontal cognitive and atrophy patterns different in PSP and bvFTD? A comparative neuropsychological and VBM study. PLoS One 2013; 8:e80353. [PMID: 24278277 PMCID: PMC3835584 DOI: 10.1371/journal.pone.0080353] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 10/02/2013] [Indexed: 11/18/2022] Open
Abstract
Progressive supranuclear palsy (PSP) and frontotemporal lobar degeneration (FTD) are two clinicohistological entities that share a severe prefrontal syndrome. To what extent do the cognitive syndrome and the location of the underlying brain atrophy unify or segregate these entities? Here, we examined the clinical and radiological patterns of frontal involvement and the neural bases of the cognitive dysfunctions observed in the Richardson form of PSP and the behavioral variant of FTD (bvFTD). The cognitive profile and grey and white matter volume of PSP (n = 19) and bvFTD (n = 16) patients and control participants (n = 18) were compared using a standard battery of neuropsychological tests and voxel-based morphometry (VBM), respectively. Analyses of correlations between neuropsychological and morphometric data were additionally performed. The severity and qualitative pattern of cognitive dysfunction was globally similar between the two patient groups. Grey matter volume was decreased in widespread frontal areas and in the temporal uncus in bvFTD, while it was decreased in the frontal and temporal lobes as well as in the thalamus in PSP. We also found an unexpected involvement of the frontal rectal gyrus in PSP patients compared to controls. Correlation analyses yielded different results in the two groups, with no area showing significant correlations in PSP patients, while several frontal and some temporal areas did so in bvFTD patients. In spite of minor neuropsychological and morphological differences, this study shows that the patterns of cognitive dysfunction and atrophy are very similar in PSP and bvFTD. However, executive dysfunction in these diseases may stem from partially divergent cortical and subcortical neural circuits.
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Affiliation(s)
- Julien Lagarde
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
| | - Romain Valabrègue
- Centre de NeuroImagerie de Recherche (CENIR), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
- Université Pierre et Marie Curie- Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Paris, France
| | - Jean-Christophe Corvol
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
- Université Pierre et Marie Curie- Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Paris, France
- INSERM, Centre d'Investigation Clinique, CIC-9503, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Fanny Pineau
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, Centre d'Investigation Clinique, CIC-9503, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Isabelle Le Ber
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
- Université Pierre et Marie Curie- Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Paris, France
- National reference center on rare dementias, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Marie Vidailhet
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
- Université Pierre et Marie Curie- Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Paris, France
| | - Bruno Dubois
- Department of Neurology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
- Université Pierre et Marie Curie- Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Paris, France
- National reference center on rare dementias, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Richard Levy
- Department of Neurology, AP-HP, Hôpital Saint-Antoine, Paris, France
- INSERM, UMR-975, CNRS, UMR-7225, Paris, France
- Université Pierre et Marie Curie- Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (ICM), UMR-S975, Paris, France
- * E-mail:
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Hellwig S, Frings L, Bormann T, Kreft A, Amtage F, Spehl TS, Weiller C, Tüscher O, Meyer PT. Neural correlates of cognitive dysfunction in Lewy body diseases and tauopathies: combined assessment with FDG-PET and the CERAD test battery. BRAIN AND LANGUAGE 2013; 127:307-314. [PMID: 24183466 DOI: 10.1016/j.bandl.2013.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 09/05/2013] [Accepted: 10/09/2013] [Indexed: 06/02/2023]
Abstract
We investigated disease-specific cognitive profiles and their neural correlates in Lewy-body diseases (LBD) and tauopathies by CERAD assessment and FDG-PET. Analyses revealed a significant interaction between reduced semantic fluency in tauopathies and impaired verbal learning in LBD. Semantic fluency discriminated between groups with high accuracy (83%). Compared to LBD, tauopathy patients showed bilateral hypometabolism of midbrain, thalamus, middle cingulate gyrus and supplementary motor/premotor cortex. In the reverse contrast, LBD patients exhibited bilateral hypometabolism in posterior parietal cortex, precuneus and inferior temporal gyrus extending into occipital and frontal cortices. In diagnosis-independent voxel-based analyses, verbal learning/memory correlated with left temporal and right parietal metabolism, while fluency was coupled to bilateral striatal and frontal metabolism. Naming correlated with left frontal metabolism and drawing with metabolism in bilateral temporal and left frontal regions. In line with disease-specific patterns of regional glucose metabolism, tauopathies and LBD show distinct cognitive profiles, which may assist clinical differentiation.
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Affiliation(s)
- Sabine Hellwig
- Department of Neurology, University Hospital Freiburg, Freiburg, Germany; Department of Psychiatry, University Hospital Freiburg, Freiburg, Germany.
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85
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dell'Aquila C, Zoccolella S, Cardinali V, de Mari M, Iliceto G, Tartaglione B, Lamberti P, Logroscino G. Predictors of survival in a series of clinically diagnosed progressive supranuclear palsy patients. Parkinsonism Relat Disord 2013; 19:980-5. [DOI: 10.1016/j.parkreldis.2013.06.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 05/21/2013] [Accepted: 06/24/2013] [Indexed: 11/26/2022]
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A longitudinal study of motor, oculomotor and cognitive function in progressive supranuclear palsy. PLoS One 2013; 8:e74486. [PMID: 24058574 PMCID: PMC3769232 DOI: 10.1371/journal.pone.0074486] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 08/02/2013] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE We studied the annual change in measures of motor, oculomotor and cognitive function in progressive supranuclear palsy. This had twin objectives, to assess the potential for clinical parameters to monitor disease progression in clinical trials and to illuminate the progression of pathophysiology. METHODS Twenty three patients with progressive supranuclear palsy (Richardson's syndrome) were compared to 22 matched controls at baseline and 16 of these patients compared at baseline and one year using: the progressive supranuclear palsy rating scale; the unified Parkinson's disease rating scale; the revised Addenbrooke's cognitive examination; the frontal assessment battery; the cubes section of the visual object and space perception battery; the Hayling and Brixton executive tests; and saccadic latencies. RESULTS Patients were significantly impaired in all domains at baseline. However, cognitive performance was maintained over a year on the majority of tests. The unified Parkinson's disease rating scale, saccadic latency and progressive supranuclear palsy rating scale deteriorated over a year, with the latter showing the largest change. Power estimates indicate that using the progressive supranuclear palsy rating scale as an outcome measure in a clinical trial would require 45 patients per arm, to identify a 50% reduction in rate of decline with 80% power. CONCLUSIONS Motor, oculomotor and cognitive domains deteriorate at different rates in progressive supranuclear palsy. This may be due to differential degeneration of their respective cortical-subcortical circuits, and has major implications for the selection of outcome measures in clinical trials due to wide variation in sensitivity to annual rates of decline.
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87
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The clinical and anatomical heterogeneity of environmental dependency phenomena. J Neurol 2013; 260:2262-70. [PMID: 23744303 DOI: 10.1007/s00415-013-6976-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/17/2013] [Accepted: 05/19/2013] [Indexed: 10/26/2022]
Abstract
Following damage to the frontal lobes, the observation of patients presenting with environmental dependency syndrome (EDS), particularly with its two main components--grasping and imitation behavior, provides a unique opportunity to gain new insights into the neural bases of human autonomy and free-will. In the present study, thirty-nine patients with frontal lobe dysfunction [21 with progressive supranuclear palsy (PSP), and 18 with the behavioral variant of frontotemporal dementia, (bvFTD)] were tested for environmental dependency phenomena and underwent neuropsychological evaluation and T1-weighted 3D brain MRI. We correlated scores obtained by assessing grasping, imitation and utilization behaviors with both neuropsychological executive test performance and grey matter density on MRI using Voxel-Based Morphometry (VBM). This study confirms the high frequency of two environmental dependency phenomena- grasping and imitation- in patients with frontal lobe syndrome (34/39 patients) and the rarity of utilization behavior (2/39). The grasping score was significantly and positively correlated with those obtained in all executive tests except the Stroop test, while the imitation score was not. In the VBM study, while the grasping score was correlated with grey matter density in the right superior frontal gyrus and both inferior temporal gyri, the imitation score was correlated with changes in the right insula, left medial frontal gyrus and left precuneus. Environmental dependency is associated with the dysfunction of a frontoparietal network. Within this large network, grasping and imitation behaviors can be dissociated from both neuropsychological and anatomical standpoints, underlining the clinical and anatomical heterogeneity of environmental dependency phenomena.
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88
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Stamelou M, Quinn NP, Bhatia KP. “Atypical” atypical parkinsonism: New genetic conditions presenting with features of progressive supranuclear palsy, corticobasal degeneration, or multiple system atrophy-A diagnostic guide. Mov Disord 2013; 28:1184-99. [DOI: 10.1002/mds.25509] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/01/2013] [Accepted: 04/09/2013] [Indexed: 12/13/2022] Open
Affiliation(s)
- Maria Stamelou
- Sobell Department of Motor Neuroscience and Movement Disorders; UCL Institute of Neurology; London United Kingdom
- Neurology Clinic; Philipps-University; Marburg Germany
| | - Niall P. Quinn
- Sobell Department of Motor Neuroscience and Movement Disorders; UCL Institute of Neurology; London United Kingdom
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders; UCL Institute of Neurology; London United Kingdom
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89
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Gerstenecker A, Mast B, Duff K, Ferman TJ, Litvan I. Executive dysfunction is the primary cognitive impairment in progressive supranuclear palsy. Arch Clin Neuropsychol 2012; 28:104-13. [PMID: 23127882 DOI: 10.1093/arclin/acs098] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cognitive difficulties appear to be a more prevalent clinical feature in progressive supranuclear palsy (PSP) than previously thought, and significant cognitive impairment is prevalent in a majority of patients PSP patients not considered clinically demented. The neurocognitive performance of 200 patients with PSP across multiple sites was examined with a variety of commonly used neuropsychological tests. Results indicate primary executive dysfunction (e.g., 74% impaired on the Frontal Assessment Battery, 55% impaired on Initiation/Perseveration subscale of the Dementia Rating Scale), with milder difficulties in memory, construction, and naming. These results have important clinical implications for providers following patients with PSP.
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Affiliation(s)
- Adam Gerstenecker
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292 USA
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90
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Boxer AL, Garbutt S, Seeley WW, Jafari A, Heuer HW, Mirsky J, Hellmuth J, Trojanowski JQ, Huang E, DeArmond S, Neuhaus J, Miller BL. Saccade abnormalities in autopsy-confirmed frontotemporal lobar degeneration and Alzheimer disease. ACTA ACUST UNITED AC 2012; 69:509-17. [PMID: 22491196 DOI: 10.1001/archneurol.2011.1021] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Deficits in the generation and control of saccades have been described in clinically defined frontotemporal dementia (FTD) and Alzheimer disease (AD). OBJECTIVE To determine the saccade abnormalities associated with autopsy-defined cases of frontotemporal lobar degeneration (FTLD) and of AD, because clinical FTD syndromes can correspond to a number of different underlying neuropathologic FTD and non-FTD diagnoses. DESIGN An infrared eye tracker was used to record visually guided saccades to 10° targets and antisaccades in subjects with autopsy-confirmed FTD and subjects with autopsy-confirmed AD, a mean (SE) of 35.6 (10.0) months prior to death, and age-matched normal controls. Twelve subjects with FTD had an FTLD-TAR DNA-binding protein 43 pathology, 15 had an FTLD-tau pathology, and 1 subject showed an FTLD-fused in sarcoma protein pathology. Receiver operating curve statistics were used to determine the diagnostic value of the oculomotor variables. Neuroanatomical correlates of oculomotor abnormalities were investigated using voxel-based morphometry. SETTING Memory and Aging Center, Department of Neurology, University of California, San Francisco. PARTICIPANTS A total of 28 subjects with autopsy-confirmed FTD, 10 subjects with autopsy-confirmed AD, and 27 age-matched normal controls. RESULTS All subjects with FTD or AD were impaired relative to normal controls on the antisaccade task. However, only FTLD-tau and AD cases displayed reflexive visually guided saccade abnormalities. The AD cases displayed prominent increases in horizontal saccade latency that differentiated them from the FTD cases. Impairments in velocity and gain were most severe in individuals with progressive supranuclear palsy but were also present in other tauopathies. By using vertical and horizontal saccade velocity and gain as our measures, we were able to differentiate patients with progressive supranuclear palsy from other patients. Vertical saccade velocity was strongly correlated with dorsal midbrain volume. CONCLUSION Decreased visually guided saccade velocity and gain are suggestive of underlying tau pathology in FTD, with vertical saccade abnormalities most diagnostic of progressive supranuclear palsy.
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Affiliation(s)
- Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California-San Francisco, CA 94143-1207, USA.
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91
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Prioni S, Fetoni V, Barocco F, Redaelli V, Falcone C, Soliveri P, Tagliavini F, Scaglioni A, Caffarra P, Concari L, Gardini S, Girotti F. Stereotypic behaviors in degenerative dementias. J Neurol 2012; 259:2452-9. [DOI: 10.1007/s00415-012-6528-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 04/15/2012] [Accepted: 04/17/2012] [Indexed: 11/29/2022]
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92
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Ghosh BCP, Calder AJ, Peers PV, Lawrence AD, Acosta-Cabronero J, Pereira JM, Hodges JR, Rowe JB. Social cognitive deficits and their neural correlates in progressive supranuclear palsy. ACTA ACUST UNITED AC 2012; 135:2089-102. [PMID: 22637582 PMCID: PMC3381722 DOI: 10.1093/brain/aws128] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although progressive supranuclear palsy is defined by its akinetic rigidity, vertical supranuclear gaze palsy and falls, cognitive impairments are an important determinant of patients’ and carers’ quality of life. Here, we investigate whether there is a broad deficit of modality-independent social cognition in progressive supranuclear palsy and explore the neural correlates for these. We recruited 23 patients with progressive supranuclear palsy (using clinical diagnostic criteria, nine with subsequent pathological confirmation) and 22 age- and education-matched controls. Participants performed an auditory (voice) emotion recognition test, and a visual and auditory theory of mind test. Twenty-two patients and 20 controls underwent structural magnetic resonance imaging to analyse neural correlates of social cognition deficits using voxel-based morphometry. Patients were impaired on the voice emotion recognition and theory of mind tests but not auditory and visual control conditions. Grey matter atrophy in patients correlated with both voice emotion recognition and theory of mind deficits in the right inferior frontal gyrus, a region associated with prosodic auditory emotion recognition. Theory of mind deficits also correlated with atrophy of the anterior rostral medial frontal cortex, a region associated with theory of mind in health. We conclude that patients with progressive supranuclear palsy have a multimodal deficit in social cognition. This deficit is due, in part, to progressive atrophy in a network of frontal cortical regions linked to the integration of socially relevant stimuli and interpretation of their social meaning. This impairment of social cognition is important to consider for those managing and caring for patients with progressive supranuclear palsy.
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Affiliation(s)
- Boyd C P Ghosh
- Wessex Neurosciences Centre, Mailpoint 101, Southampton University Hospitals NHS Trust, Tremona Road, Southampton SO16 6YD, UK.
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93
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Coon EA, Whitwell JL, Jack CR, Josephs KA. Primary lateral sclerosis as progressive supranuclear palsy: diagnosis by diffusion tensor imaging. Mov Disord 2012; 27:903-6. [PMID: 22517038 DOI: 10.1002/mds.24990] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 01/31/2012] [Accepted: 03/09/2012] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Evaluating the integrity of white matter tracts with diffusion tensor imaging may differentiate primary lateral sclerosis from progressive supranuclear palsy. METHODS Thirty-three prospectively recruited subjects had standardized evaluations and diffusion tensor imaging: 3 with primary lateral sclerosis who presented with features suggestive of progressive supranuclear palsy, 10 with probable or definite progressive supranuclear palsy, and 20 matched controls. We compared fractional anisotropy of the corticospinal tract, superior cerebellar peduncles, and body of the corpus callosum between groups. RESULTS Both the primary lateral sclerosis and progressive supranuclear palsy subjects showed reduced fractional anisotropy in superior cerebellar peduncle and body of the corpus callosum compared with controls, but only primary lateral sclerosis subjects showed reductions in the corticospinal tracts. A ratio of corticospinal tract/superior cerebellar peduncle best distinguished the disorders (P < .02). CONCLUSIONS The corticospinal tract/superior cerebellar peduncle ratio is a marker to differentiate primary lateral sclerosis from progressive supranuclear palsy.
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Affiliation(s)
- Elizabeth A Coon
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, Minnesota 55905, USA
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94
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Williams DR, Lee W. Clinical features and criteria for the diagnosis of progressive supranuclear palsy. Neurodegener Dis Manag 2012. [DOI: 10.2217/nmt.11.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY The neurofibrillary tau pathology of progressive supranuclear palsy (PSP) has been associated with a number of different clinical syndromes that all ultimately lead to death and disability within 6–10 years. In 1964, Steele, Richardson and Olszewski predicted that the classic clinical syndrome they had described was specific to the topographic distribution of PSP–tau neurodegeneration and that other clinical syndromes may occur if other brain regions were affected. The spectrum of clinical disease related to PSP–tau pathology is indeed broader than 40 years ago. In addition to the classic form of PSP (Richardson’s syndrome), a number of clinical variants caused by the same neurodegenerative process have been identified. These include PSP–Parkinsonism, PSP–corticobasal syndrome, PSP–pure akinesia with gait freezing and PSP–progressive nonfluent aphasia. Here we review the clinical pictures of these syndromes and propose practical diagnostic guidelines to aid the clinician in tackling the challenges presented by the multifaceted condition of PSP–tau pathology.
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Affiliation(s)
- David R Williams
- Neuroscience Department, Alfred Hospital, Melbourne, Victoria, Australia; Van Cleef Roet Center for Nervous Diseases, Monash University, Commercial Road, Melbourne 3004, Australia
| | - Will Lee
- Neuroscience Department, Alfred Hospital, Melbourne, Victoria, Australia; Van Cleef Roet Center for Nervous Diseases, Monash University, Commercial Road, Melbourne 3004, Australia
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95
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Abstract
Tauopathies are a group of disorders that have in common abnormal accumulation of tau protein in the brain. Although the different tauopathies have long been considered to be separate diseases, it is now clear that progressive supranuclear palsy, corticobasal degeneration and some forms of tau-positive frontotemporal lobar degeneration share clinical, pathological and genetic features. The important overlap between these disorders suggest they may represent different phenotypes of a single disease process, the clinical result depending on the topography of pathological lesions as well as other unknown factors.
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96
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Shany-Ur T, Poorzand P, Grossman SN, Growdon ME, Jang JY, Ketelle RS, Miller BL, Rankin KP. Comprehension of insincere communication in neurodegenerative disease: lies, sarcasm, and theory of mind. Cortex 2011; 48:1329-41. [PMID: 21978867 DOI: 10.1016/j.cortex.2011.08.003] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 07/16/2011] [Accepted: 08/12/2011] [Indexed: 01/14/2023]
Abstract
Comprehension of insincere communication is an important aspect of social cognition requiring visual perspective taking, emotion reading, and understanding others' thoughts, opinions, and intentions. Someone who is lying intends to hide their insincerity from the listener, while a sarcastic speaker wants the listener to recognize they are speaking insincerely. We investigated whether face-to-face testing of comprehending insincere communication would effectively discriminate among neurodegenerative disease patients with different patterns of real-life social deficits. We examined ability to comprehend lies and sarcasm from a third-person perspective, using contextual cues, in 102 patients with one of four neurodegenerative diseases (behavioral variant frontotemporal dementia [bvFTD], Alzheimer's disease [AD], progressive supranuclear palsy [PSP], and vascular cognitive impairment) and 77 healthy older adults (normal controls--NCs). Participants answered questions about videos depicting social interactions involving deceptive, sarcastic, or sincere speech using The Awareness of Social Inference Test. All subjects equally understood sincere remarks, but bvFTD patients displayed impaired comprehension of lies and sarcasm compared with NCs. In other groups, impairment was not disease-specific but was proportionate to general cognitive impairment. Analysis of the task components revealed that only bvFTD patients were impaired on perspective taking and emotion reading elements and that both bvFTD and PSP patients had impaired ability to represent others' opinions and intentions (i.e., theory of mind). Test performance correlated with informants' ratings of subjects' empathy, perspective taking and neuropsychiatric symptoms in everyday life. Comprehending insincere communication is complex and requires multiple cognitive and emotional processes vulnerable across neurodegenerative diseases. However, bvFTD patients show uniquely focal and severe impairments at every level of theory of mind and emotion reading, leading to an inability to identify obvious examples of deception and sarcasm. This is consistent with studies suggesting this disease targets a specific neural network necessary for perceiving social salience and predicting negative social outcomes.
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Affiliation(s)
- Tal Shany-Ur
- Department of Neurology, University of California, San Francisco 94143-1207, USA
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97
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Cardoso F, Hodges J, Evans AH, Revesz T, Williams DR. Postural instability, frontotemporal dementia, and ophthalmoplegia: clinicopathological case. Mov Disord 2011; 26:1808-13. [PMID: 21755535 DOI: 10.1002/mds.23359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 06/28/2010] [Indexed: 11/06/2022] Open
Abstract
A 56-year-old man presented with gait disturbance, personality change, and behavioral disturbances. He subsequently developed falls, postural instability, and axial rigidity. The cognitive problems progressed and he developed aphasia and later eye movement abnormalities. He died after 9 years of disease. Experts discuss the syndromal diagnosis and predict the underlying pathology. The pathological diagnosis is given and clinical learning points are considered.
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Affiliation(s)
- Francisco Cardoso
- Movement Disorders Unit, Neurology Service, Federal University of Minas Gerais, Belo Horizonte, Brazil
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98
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Tremolizzo L, Bertola F, Casati G, Piperno A, Ferrarese C, Appollonio I. Progressive supranuclear palsy-like phenotype caused by progranulin p.Thr272fs mutation. Mov Disord 2011; 26:1964-6. [PMID: 21542024 DOI: 10.1002/mds.23749] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 03/11/2011] [Accepted: 03/15/2011] [Indexed: 11/11/2022] Open
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99
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Srulijes K, Mallien G, Bauer S, Dietzel E, Gröger A, Ebersbach G, Berg D, Maetzler W. In vivo comparison of Richardson's syndrome and progressive supranuclear palsy-parkinsonism. J Neural Transm (Vienna) 2011; 118:1191-7. [PMID: 21207078 DOI: 10.1007/s00702-010-0563-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 12/08/2010] [Indexed: 11/28/2022]
Abstract
Richardson's syndrome (RS) and progressive supranuclear palsy-parkinsonism (PSP-P) are the most common subtypes of PSP. Post-mortem data suggests that the clinical presentation of the two subtypes differs especially in the first 2 years of disease and then converges. This hypothesis has, to our knowledge, never been confirmed in a living cohort. Medical history was used to define subtypes retrospectively in 23 consecutive PSP patients from our outpatient clinic specialized in movement disorders. 14 patients suffered from RS, and 9 from PSP-P. Using a prospective cross-sectional approach, clinical, cognitive, behavioral, speech and biochemical (cerebrospinal fluid tau levels) features were compared. RS patients showed shorter time from disease onset to diagnosis and more neuropsychological and neurobehavioral deficits than PSP-P patients, but differed not significantly with regard to clinical and biochemical features. RS and PSP-P show considerable symptoms overlap during the disease course when using routine assessments, with persisting differences regarding non-motor symptoms. Shorter disease duration of the comparably affected RS patients indicates that this subtype has an accelerated disease progression at early disease stages.
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Affiliation(s)
- Karin Srulijes
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
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100
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Stamelou M, Knake S, Oertel WH, Höglinger GU. Magnetic resonance imaging in progressive supranuclear palsy. J Neurol 2010; 258:549-58. [PMID: 21181185 DOI: 10.1007/s00415-010-5865-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 11/20/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
Abstract
Progressive supranuclear palsy (PSP) is a tauopathy, presenting clinically most often with a symmetrical akinetic-rigid syndrome, postural instability, supranuclear gaze palsy and frontal dementia. In the absence of reliably validated biomarkers, the diagnosis of PSP in vivo is presently based on clinical criteria, which to date do not include supporting imaging findings, as is accepted for other neurodegenerative diseases. However, data from conventional magnetic resonance imaging (MRI) and various advanced MRI techniques including magnetic resonance volumetry, voxel-based morphometry, diffusion-weighted and diffusion-tensor imaging, magnetization transfer imaging and proton resonance spectroscopy suggest that MRI can contribute valuable information for the differential diagnosis of PSP. We review here the presently published literature concerning MRI in PSP and discuss the potential role of MRI in differentiating PSP from other parkinsonian syndromes.
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Affiliation(s)
- M Stamelou
- Department of Neurology, Philipps University, Rudolf-Bultmann Str. 8, 35033, Marburg, Germany.
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