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Chang TY, Yang CP, Chen YH, Lin CH, Chang MH. Age-Stratified Risk of Dementia in Parkinson's Disease: A Nationwide, Population-Based, Retrospective Cohort Study in Taiwan. Front Neurol 2022; 12:748096. [PMID: 35002917 PMCID: PMC8740231 DOI: 10.3389/fneur.2021.748096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Parkinson's disease (PD) manifests with dominant motor symptoms and a wide range of non-motor symptoms (NMS). Dementia is one of the most disabling and exhausting NMS throughout the clinical course. We conducted a population-based, age-stratified, retrospective cohort study to investigate the incidence rate and risk of dementia of patients with newly diagnosed PD, and linked to the clinicopathological PD subtypes. Methods: Patients with newly diagnosed PD (PD group, n = 760) and control subjects (non-PD group, n = 3,034) were selected from the Taiwan's National Health Insurance Research Database from January 2001 to December 2005. The dementia incidence rate and dementia-free survival rate were calculated. Results: The overall dementia incidence rate was 17.5 and 5.7 per 1,000 person-years in PD and non-PD groups, respectively. The PD group had a significantly higher overall risk of dementia than controls (p < 0.001). The younger PD patients had a lower dementia incidence rate than the older PD patients, but a higher dementia risk compared to the same age of controls (<60 years, adjusted HR 6.55, 95% CI 1.56–27.48, p = 0.010). The dementia-free survival rate was significantly lower in the PD group compared to the non-PD group during follow-up (p < 0.001). Conclusion: In our study, the older age of onset in PD patients resulted in a higher incidence rate of dementia. In the young age of PD patients, the incidence rate of dementia was lower than the older PD patients, but the dementia risk was higher than controls of the same age. These findings possibly implied that there were different pathogenesis and pathologies causing dementia in younger and older PD patients.
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Affiliation(s)
- Ting-Ya Chang
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Pai Yang
- Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Yi-Huei Chen
- Department of Medical Education and Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Education and Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Hong Chang
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Chung Hsing University, Taichung, Taiwan
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Martínez-Horta S, Bejr-Kasem H, Horta-Barba A, Pascual-Sedano B, Santos-García D, de Deus-Fonticoba T, Jesús S, Aguilar M, Planellas L, García-Caldentey J, Caballol N, Vives-Pastor B, Hernández-Vara J, Cabo-Lopez I, López-Manzanares L, González-Aramburu I, Ávila-Rivera MA, Catalán MJ, López-Díaz LM, Puente V, García-Moreno JM, Borrué C, Solano-Vila B, Álvarez-Sauco M, Vela L, Escalante S, Cubo E, Carrillo-Padilla F, Martínez-Castrillo JC, Sánchez-Alonso P, Alonso-Losada MG, López-Ariztegui N, Gastón I, Blázquez-Estrada M, Seijo-Martínez M, Rúiz-Martínez J, Valero-Merino C, Kurtis M, de Fábregues-Boixar O, González-Ardura J, Prieto-Jurczynska C, Martinez-Martin P, Mir P, Kulisevsky J. Identifying comorbidities and lifestyle factors contributing to the cognitive profile of early Parkinson's disease. BMC Neurol 2021; 21:477. [PMID: 34879838 PMCID: PMC8653592 DOI: 10.1186/s12883-021-02485-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying modifiable risk factors for cognitive impairment in the early stages of Parkinson's disease (PD) and estimating their impact on cognitive status may help prevent dementia (PDD) and the design of cognitive trials. METHODS Using a standard approach for the assessment of global cognition in PD and controlling for the effects of age, education and disease duration, we explored the associations between cognitive status, comorbidities, metabolic variables and lifestyle variables in 533 PD participants from the COPPADIS study. RESULTS Among the overall sample, 21% of participants were classified as PD-MCI (n = 114) and 4% as PDD (n = 26). The prevalence of hypertension, diabetes and dyslipidemia was significantly higher in cognitively impaired patients while no between-group differences were found for smoking, alcohol intake or use of supplementary vitamins. Better cognitive scores were significantly associated with regular physical exercise (p < 0.05) and cognitive stimulation (< 0.01). Cognitive performance was negatively associated with interleukin 2 (Il2) (p < 0.05), Il6 (p < 0.05), iron (p < 0.05), and homocysteine (p < 0.005) levels, and positively associated with vitamin B12 levels (p < 0.005). CONCLUSIONS We extend previous findings regarding the positive and negative influence of various comorbidities and lifestyle factors on cognitive status in early PD patients, and reinforce the need to identify and treat potentially modifiable variables with the intention of exploring the possible improvement of the global cognitive status of patients with PD.
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Affiliation(s)
- Saul Martínez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Helena Bejr-Kasem
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Andrea Horta-Barba
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Berta Pascual-Sedano
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | | | | | - Silvia Jesús
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Miquel Aguilar
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | | | - Juan García-Caldentey
- Hospital Quiron Palmaplanas, Clínica Rotger y Centro Neurológico Oms 42, Palma de Mallorca, Spain
| | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | | | - Jorge Hernández-Vara
- Neurology Department and Neurodegenerative Diseases Research Group, Vall D'Hebron Universitari Campus, Barcelona, Spain
| | - Iria Cabo-Lopez
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | | | | | | | | | | | | | - Carmen Borrué
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Berta Solano-Vila
- Hospital Universitari Josep Trueta y Hospital Santa Caterina, Girona, Spain
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - Sonia Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC), Tortosa, Tarragona, Spain
| | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Francisco Carrillo-Padilla
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica. Hospital Universitario de Canarias, Tenerife, Spain
| | | | | | | | - Nuria López-Ariztegui
- Servicio de Neurología, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | | | | | | | | | | | | | - Oriol de Fábregues-Boixar
- Neurology Department and Neurodegenerative Diseases Research Group, Vall D'Hebron Universitari Campus, Barcelona, Spain
| | | | | | - Pablo Martinez-Martin
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Centro Nacional de Epidemiología y CIBERNED, Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo Mir
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain. .,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain. .,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
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Alpha-Synuclein and Cognitive Decline in Parkinson Disease. Life (Basel) 2021; 11:life11111239. [PMID: 34833115 PMCID: PMC8625417 DOI: 10.3390/life11111239] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022] Open
Abstract
Parkinson disease (PD) is the second most common neurodegenerative disorder in elderly people. It is characterized by the aggregation of misfolded alpha-synuclein throughout the nervous system. Aside from cardinal motor symptoms, cognitive impairment is one of the most disabling non-motor symptoms that occurs during the progression of the disease. The accumulation and spreading of alpha-synuclein pathology from the brainstem to limbic and neocortical structures is correlated with emerging cognitive decline in PD. This review summarizes the genetic and pathophysiologic relationship between alpha-synuclein and cognitive impairment in PD, together with potential areas of biomarker advancement.
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Guglietti B, Hobbs D, Collins-Praino LE. Optimizing Cognitive Training for the Treatment of Cognitive Dysfunction in Parkinson's Disease: Current Limitations and Future Directions. Front Aging Neurosci 2021; 13:709484. [PMID: 34720988 PMCID: PMC8549481 DOI: 10.3389/fnagi.2021.709484] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/17/2021] [Indexed: 01/09/2023] Open
Abstract
Cognitive dysfunction, primarily involving impairments in executive function, visuospatial function and memory, is one of the most common non-motor symptoms of Parkinson’s disease (PD). Currently, the only pharmacological treatments available for the treatment of cognitive dysfunction in PD provide variable benefit, making the search for potential non-pharmacological therapies to improve cognitive function of significant interest. One such therapeutic strategy may be cognitive training (CT), which involves the repetition of standardized tasks with the aim of improving specific aspects of cognition. Several studies have examined the effects of CT in individuals with PD and have shown benefits in a variety of cognitive domains, but the widespread use of CT in these individuals may be limited by motor impairments and other concerns in study design. Here, we discuss the current state of the literature on the use of CT for PD and propose recommendations for future implementation. We also explore the potential use of more recent integrative, adaptive and assistive technologies, such as virtual reality, which may optimize the delivery of CT in PD.
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Affiliation(s)
- Bianca Guglietti
- Cognition, Ageing and Neurodegenerative Disease Laboratory, Department of Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - David Hobbs
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, Australia.,Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Lyndsey E Collins-Praino
- Cognition, Ageing and Neurodegenerative Disease Laboratory, Department of Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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55
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Liu Y, Qiu MY, Zhang YL, Zhang XJ, Truong D, Tan EK, Wu YC. Fist-Edge-Palm (FEP) test has a high sensitivity in differentiating dementia from normal cognition in Parkinson's disease. J Neurol Sci 2021; 429:118060. [PMID: 34479167 DOI: 10.1016/j.jns.2021.118060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Fist-Edge-Palm (FEP) test takes 0.5-3 min to complete and is highly sensitive in differentiating Alzheimer's disease and frontotemporal dementia from normal cognition, but it has not yet been studied in Parkinson's disease (PD). OBJECTIVE To determine the sensitivity and specificity of the FEP test in screening patients with PD for cognitive impairment and dementia. METHODS PD patients were recruited and divided into three groups based on cognitive status: normal cognition, mild cognitive impairment (MCI) and dementia according to 2015 MDS clinical diagnostic criteria for PD and clinical dementia rating scale (CDR) assessment for cognitive status. MMSE, FEP and clock drawing test (CDT) were tested in all recruited PD patients. Chi-square test was used to compare the sensitivity of FEP and CDT in detecting PDD and PD-MCI. RESULTS A total of 108 PD patients were included: 52 normal cognition, 28 MCI, and 28 dementia. The sensitivity of FEP in differentiating PDD from PD-NC was 96.4% and the sensitivity for PD-MCI from PD-NC was 71.4%. The sensitivity of CDT in differentiating PDD from PD-NC was 71.4% and PD-MCI from PD-NC was 53.6%. The sensitivities of FEP and CDT were 83.9% and 62.5%, respectively, in identifying cognitive impairment (CDR ≥ 0.5) in PD patients. CONCLUSION FEP is a sensitive screening tool in differentiating PDD or PD-MCI from PD-NC, and it is much faster than MMSE and more sensitive than CDT. FEP may be a practical screening tool for daily clinical practice.
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Affiliation(s)
- Ye Liu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, PR China
| | - Meng-Yao Qiu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, PR China
| | - Yu-Lei Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, PR China
| | - Xiao-Jin Zhang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, PR China
| | - Daniel Truong
- The Truong Neurosciences Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA, United States; Department of Neurosciences and Psychiatry, University of California, Riverside, Riverside, CA, United States.
| | - Eng-King Tan
- Department of Neurology, National Neuroscience Institute, 169608, Singapore.
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, PR China.
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De Roy J, Postuma RB, Brillon-Corbeil M, Montplaisir J, Génier Marchand D, Escudier F, Panisset M, Chouinard S, Gagnon JF. Detecting the Cognitive Prodrome of Dementia in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 10:1033-1046. [PMID: 32310188 DOI: 10.3233/jpd-191857] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND More than 75% of Parkinson's disease (PD) patients will develop dementia. Previous studies on the cognitive predictors of dementia in PD had some methodological limitations and the cognitive tests identified as good predictors vary greatly. OBJECTIVE This prospective cohort study aims to identify the optimal cognitive predictors of dementia in PD using complementary statistical methods. METHODS Eighty PD patients without dementia underwent polysomnographic recording, a neurological examination, and a complete neuropsychological assessment at baseline. They were then followed for a mean of 4.3 years. Baseline group comparisons and survival analyses were used to identify optimal cognitive predictors. Moreover, patients who developed dementia were pair-matched at baseline according to age, sex, and education to healthy controls (2 : 1), and receiver operating characteristic curves were calculated for cognitive tests. RESULTS At follow-up, 23 patients (29%) developed dementia. PD patients who developed dementia had poorer baseline performance and a higher proportion of clinically impaired performance on several cognitive tests. Impaired baseline performance on the Block Design subtest was the best independent predictor of dementia (HR = 8). Moreover, the Trail Making Test part B (time) and Verbal Fluency (semantic) had the best psychometric properties (area under the curve >0.90) for identifying PD patients at risk of dementia. CONCLUSION The present study identified three cognitive tests as the most accurate to detect individuals with PD at high risk of developing dementia.
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Affiliation(s)
- Jessie De Roy
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Neurology, Montreal General Hospital, Montreal, QC, Canada
| | - Marina Brillon-Corbeil
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Daphné Génier Marchand
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Frédérique Escudier
- Research Centre, Institut Universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Michel Panisset
- Unité des troubles du mouvement André Barbeau, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Sylvain Chouinard
- Unité des troubles du mouvement André Barbeau, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.,Research Centre, Institut Universitaire de gériatrie de Montréal, Montreal, QC, Canada
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Brain age and Alzheimer's-like atrophy are domain-specific predictors of cognitive impairment in Parkinson's disease. Neurobiol Aging 2021; 109:31-42. [PMID: 34649002 DOI: 10.1016/j.neurobiolaging.2021.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/20/2022]
Abstract
Recently, it was shown that patients with Parkinson's disease (PD) who exhibit an "Alzheimer's disease (AD)-like" pattern of brain atrophy are at greater risk for future cognitive decline. This study aimed to investigate whether this association is domain-specific and whether atrophy associated with brain aging also relates to cognitive impairment in PD. SPARE-AD, an MRI index capturing AD-like atrophy, and atrophy-based estimates of brain age were computed from longitudinal structural imaging data of 178 PD patients and 84 healthy subjects from the LANDSCAPE cohort. All patients underwent an extensive neuropsychological test battery. Patients diagnosed with mild cognitive impairment or dementia were found to have higher SPARE-AD scores as compared to patients with normal cognition and healthy controls. All patient groups showed increased brain age. SPARE-AD predicted impairment in memory, language and executive functions, whereas advanced brain age was associated with deficits in attention and working memory. Data suggest that SPARE-AD and brain age are differentially related to domain-specific cognitive decline in PD. The underlying pathomechanisms remain to be determined.
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Kawashima S, Shimizu Y, Ueki Y, Matsukawa N. Impairment of the visuospatial working memory in the patients with Parkinson's Disease: an fMRI study. BMC Neurol 2021; 21:335. [PMID: 34479502 PMCID: PMC8414685 DOI: 10.1186/s12883-021-02366-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) is a common symptom in the patients with Parkinson's disease (PD). The characteristics of cognitive impairment in PD are executive function (including working memory) and visuo-perceptual processing. The visuospatial n-back test has the merit of minimizing the influence of educational biases involved in the verbal n-back test. Furthermore, it can assess both visuospatial recognition and working memory in a single test. METHODS We aimed to clarify the advantage of the visuospatial n-back test as a tool for detecting impairments of working memory in PD. We enrolled 28 right-handed patients with PD (18 males, 10 females) and 12 age-matched healthy controls (HC; 7 males, 5 females). Thirteen patients were classified as MCI (PD-MCI), and 15 as cognitively normal PD (PD-CN). Using functional MRI (fMRI), we explored the specific brain regions associated with the performance of the n-back test in the PD-MCI, PD-CN, and HC groups. The 0-back test assesses visuospatial recognition, while the 1-back and 2-back tests assess visuospatial working memory. Group comparisons were performed for three loads of this test. RESULTS Patients with PD performed significantly worse in terms of the correct answer rates of all n-back tests compared with HC. fMRI analyses performed during the 2-back test revealed reduced activation in the bilateral dorsolateral prefrontal cortex, middle frontal gyrus (MFG), and parietal lobule in the PD group compared with the HC group. In contrast, the fMRI result during the 0-back test showed only a marginal difference in the frontal lobe. On comparisons of task performance between the PD-MCI and PD-CN groups, we found that the correct answer rate in the 2-back test was lower in the PD-MCI group than in the PD-CN group. However, scores of the 0-back and 1-back tests were not significantly different between the two groups. The fMRI findings revealed that activations within the middle frontal gyrus (MFG) and inferior parietal lobule (IPL) during the 2-back test were reduced in the patients with PD-MCI when compared to those with PD-CN. CONCLUSIONS This study reports reduced activation of the MFG and IPL in patients with PD-MCI. These regions may be associated with the pathophysiology of working memory impairment in patients with PD, which involves fronto-striatal network dysfunction.
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Affiliation(s)
- Shoji Kawashima
- Department of Neurology and Neuroscience, Graduate School of Medical Science, Nagoya City University, 1 Kawasumi, Mizuho-ku, 467-8601, Nagoya, Japan.
| | - Yoko Shimizu
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Nagoya City University, 1 Kawasumi, Mizuho-ku, 467-8601, Nagoya, Japan
| | - Yoshino Ueki
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Nagoya City University, 1 Kawasumi, Mizuho-ku, 467-8601, Nagoya, Japan
| | - Noriyuki Matsukawa
- Department of Neurology and Neuroscience, Graduate School of Medical Science, Nagoya City University, 1 Kawasumi, Mizuho-ku, 467-8601, Nagoya, Japan
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Are Parkinson's Disease Patients the Ideal Preclinical Population for Alzheimer's Disease Therapeutics? J Pers Med 2021; 11:jpm11090834. [PMID: 34575610 PMCID: PMC8472048 DOI: 10.3390/jpm11090834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
Concomitant neuropathological hallmarks of Alzheimer's Disease (AD) are common in the brains of people with Parkinson's disease (PD). Furthermore, AD biomarkers are associated with cognitive decline and dementia in PD patients during life. Here, we highlight the considerable overlap between AD and PD, emphasizing neuropathological, biomarker, and mechanistic studies. We suggest that precision medicine approaches may successfully identify PD patients most likely to develop concomitant AD. The ability to identify PD patients at high risk for future concomitant AD in turn provides an ideal cohort for trials of AD-directed therapies in PD patients, aimed at delaying or preventing cognitive symptoms.
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Lillig R, Ophey A, Schulz JB, Reetz K, Wojtala J, Storch A, Liepelt-Scarfone I, Becker S, Berg D, Balzer-Geldsetzer M, Kassubek J, Hilker-Roggendorf R, Witt K, Mollenhauer B, Trenkwalder C, Roeske S, Wittchen HU, Riedel O, Dodel R, Kalbe E. A new CERAD total score with equally weighted z-scores and additional executive and non-amnestic "CERAD-Plus" tests enhances cognitive diagnosis in patients with Parkinson's disease: Evidence from the LANDSCAPE study. Parkinsonism Relat Disord 2021; 90:90-97. [PMID: 34418761 DOI: 10.1016/j.parkreldis.2021.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/23/2021] [Accepted: 07/31/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) is a renowned cognitive test battery, which has been extended in its German version to the CERAD-Plus including tests of executive functions and processing speed. The most commonly used total score (TS) is based on the restricted CERAD version and reflects the sum of selected raw-values (Chandler et al., 2005). The CERAD-Plus extensions might be of particular diagnostic utility for cognitive assessments in Parkinson's Disease (PD), as executive functions and processing speed belong to the most vulnerable domains in PD. OBJECTIVE The aim was to develop a CERAD-TS based on the extended CERAD-Plus' age-, gender-, and education-corrected z-scores and to evaluate its diagnostic accuracy compared to the established CERAD-Chandler-TS. METHODS Baseline data of n = 679 patients with PD (69% male, n = 277 PD without cognitive impairment, n = 307 PD-MCI, n = 95 PD-D) from the multicenter, prospective DEMPARK/LANDSCAPE study were analyzed. ROC-analyses were conducted for four different TS that were either based on the original CERAD or CERAD-Plus, on raw-values or z-scores, and equally-weighted or based on factor scores. AUC-comparisons were conducted to determine the best yet most parsimonious TS. RESULTS The newly designed CERAD-Plus-TS based on equally-weighted z-scores outperformed both the CERAD-Chandler-TS and cognitive screening instruments when differentiating between individuals with PD of varying cognitive impairment (0.78 ≤ AUC ≤ 0.98). CONCLUSION Results suggest a high relevance of non-amnestic subscales for the cognitive assessment in PD populations. The proposed CERAD-Plus-TS needs further validation. The extensions might offer diagnostic potential for non-PD populations as well.
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Affiliation(s)
- Robert Lillig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Medical Psychology
- Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostic and Intervention (CeNDI), 50937, Cologne, Germany.
| | - Anja Ophey
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Medical Psychology
- Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostic and Intervention (CeNDI), 50937, Cologne, Germany.
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, 52074, Aachen, Germany.
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, 52074, Aachen, Germany.
| | - Jennifer Wojtala
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, 52074, Aachen, Germany.
| | - Alexander Storch
- Department of Neurology, University of Rostock and German Center for Neurodegenerative Diseases (DZNE) Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany.
| | - Inga Liepelt-Scarfone
- Hertie Institute for Clinical Brain Research Department of Neurodegenerative Diseases, Otfried-Müller-Straße 27, 72076, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Otfried-Müller-Straße 23, 72076, Tübingen, Germany; IB-Hochschule für Gesundheit und Soziales, Paulinenstraße 45, 70178, Stuttgart, Germany.
| | - Sara Becker
- Hertie Institute for Clinical Brain Research Department of Neurodegenerative Diseases, Otfried-Müller-Straße 27, 72076, Tübingen, Germany.
| | - Daniela Berg
- Hertie Institute for Clinical Brain Research Department of Neurodegenerative Diseases, Otfried-Müller-Straße 27, 72076, Tübingen, Germany; Department of Neurology, Christian-Albrechts-University of Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Monika Balzer-Geldsetzer
- Ethikkommission, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8, 80336, München, Germany.
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | | | - Karsten Witt
- Department of Neurology and Research Centre of Neurosensory Sciences, Carl von Ossietzky University, Carl-von-Ossietzky-Straße 9, 26129, Oldenburg, Germany.
| | - Brit Mollenhauer
- Paracelsus-Elena Klinik, Kassel, Department of Neurosurgery, University Medical Center, Goettingen, Klinikstraße 16, 34128, Kassel, Germany.
| | - Claudia Trenkwalder
- Paracelsus-Elena Klinik, Kassel, Department of Neurosurgery, University Medical Center, Goettingen, Klinikstraße 16, 34128, Kassel, Germany.
| | - Sandra Roeske
- German Center for Neurodegenerative Diseases (DZNE), Department of Clinical Research, Bonn, Sigmund-Freud-Str. 27, 53127, Bonn, Germany.
| | - Hans-Ullrich Wittchen
- Department of Psychiatry & Psychotherapy, University Hospital Munich, Ludwig-Maximilians-University Munich, Nußbaumstraße 7, 80336, München, Germany.
| | - Oliver Riedel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Department of Clinical Epidemiology, Achterstraße 30, 28359, Bremen, Germany.
| | - Richard Dodel
- Department of Neurology, Philipps University Marburg, Baldingerstraße, 35043, Marburg, Germany; Department of Geriatric Medicine, University Hospital Essen, Germaniastrasse 1-3, 45356, Essen, Germany.
| | - Elke Kalbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Medical Psychology
- Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostic and Intervention (CeNDI), 50937, Cologne, Germany.
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TOMM40 '523' poly-T repeat length is a determinant of longitudinal cognitive decline in Parkinson's disease. NPJ PARKINSONS DISEASE 2021; 7:56. [PMID: 34234128 PMCID: PMC8263775 DOI: 10.1038/s41531-021-00200-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/11/2021] [Indexed: 12/11/2022]
Abstract
The translocase of outer mitochondrial membrane 40 (TOMM40) ‘523’ polymorphism has previously been associated with age of Alzheimer’s disease onset and cognitive functioning in non-pathological ageing, but has not been explored as a candidate risk marker for cognitive decline in Parkinson’s disease (PD). Therefore, this longitudinal study investigated the role of the ‘523’ variant in cognitive decline in a patient cohort from the Parkinson’s Progression Markers Initiative. As such, a group of 368 people with PD were assessed annually for cognitive performance using multiple neuropsychological protocols, and were genotyped for the TOMM40 ‘523’ variant using whole-genome sequencing data. Covariate-adjusted generalised linear mixed models were utilised to examine the relationship between TOMM40 ‘523’ allele lengths and cognitive scores, while taking into account the APOE ε genotype. Cognitive scores declined over the 5-year study period and were lower in males than in females. When accounting for APOE ε4, the TOMM40 ‘523’ variant was not robustly associated with overall cognitive performance. However, in APOE ε3/ε3 carriers, who accounted for ~60% of the whole cohort, carriage of shorter ‘523’ alleles was associated with more severe cognitive decline in both sexes, while carriage of the longer alleles in females were associated with better preservation of global cognition and a number of cognitive sub-domains, and with a delay in progression to dementia. The findings indicate that when taken in conjunction with the APOE genotype, TOMM40 ‘523’ allele length is a significant independent determinant and marker for the trajectory of cognitive decline and risk of dementia in PD.
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Aarsland D, Batzu L, Halliday GM, Geurtsen GJ, Ballard C, Ray Chaudhuri K, Weintraub D. Parkinson disease-associated cognitive impairment. Nat Rev Dis Primers 2021; 7:47. [PMID: 34210995 DOI: 10.1038/s41572-021-00280-3] [Citation(s) in RCA: 375] [Impact Index Per Article: 125.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 02/08/2023]
Abstract
Parkinson disease (PD) is the second most common neurodegenerative disorder, affecting >1% of the population ≥65 years of age and with a prevalence set to double by 2030. In addition to the defining motor symptoms of PD, multiple non-motor symptoms occur; among them, cognitive impairment is common and can potentially occur at any disease stage. Cognitive decline is usually slow and insidious, but rapid in some cases. Recently, the focus has been on the early cognitive changes, where executive and visuospatial impairments are typical and can be accompanied by memory impairment, increasing the risk for early progression to dementia. Other risk factors for early progression to dementia include visual hallucinations, older age and biomarker changes such as cortical atrophy, as well as Alzheimer-type changes on functional imaging and in cerebrospinal fluid, and slowing and frequency variation on EEG. However, the mechanisms underlying cognitive decline in PD remain largely unclear. Cortical involvement of Lewy body and Alzheimer-type pathologies are key features, but multiple mechanisms are likely involved. Cholinesterase inhibition is the only high-level evidence-based treatment available, but other pharmacological and non-pharmacological strategies are being tested. Challenges include the identification of disease-modifying therapies as well as finding biomarkers to better predict cognitive decline and identify patients at high risk for early and rapid cognitive impairment.
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Affiliation(s)
- Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
| | - Lucia Batzu
- Parkinson's Foundation Centre of Excellence, King's College Hospital and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Glenda M Halliday
- Brain and Mind Centre and Faculty of Medicine and Health School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Gert J Geurtsen
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - K Ray Chaudhuri
- Parkinson's Foundation Centre of Excellence, King's College Hospital and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Parkinson's Disease Research, Education and Clinical Center (PADRECC), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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63
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Gonzalez-Latapi P, Bayram E, Litvan I, Marras C. Cognitive Impairment in Parkinson's Disease: Epidemiology, Clinical Profile, Protective and Risk Factors. Behav Sci (Basel) 2021; 11:bs11050074. [PMID: 34068064 PMCID: PMC8152515 DOI: 10.3390/bs11050074] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 02/07/2023] Open
Abstract
Cognitive impairment is a common non-motor symptom in Parkinson's Disease (PD) and an important source of patient disability and caregiver burden. The timing, profile and rate of cognitive decline varies widely among individuals with PD and can range from normal cognition to mild cognitive impairment (PD-MCI) and dementia (PDD). Beta-amyloid and tau brain accumulation, oxidative stress and neuroinflammation are reported risk factors for cognitive impairment. Traumatic brain injury and pesticide and tobacco exposure have also been described. Genetic risk factors including genes such as COMT, APOE, MAPT and BDNF may also play a role. Less is known about protective factors, although the Mediterranean diet and exercise may fall in this category. Nonetheless, there is conflicting evidence for most of the factors that have been studied. The use of inconsistent criteria and lack of comprehensive assessment in many studies are important methodological issues. Timing of exposure also plays a crucial role, although identification of the correct time window has been historically difficult in PD. Our understanding of the mechanism behind these factors, as well as the interactions between gene and environment as determinants of disease phenotype and the identification of modifiable risk factors will be paramount, as this will allow for potential interventions even in established PD.
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Affiliation(s)
- Paulina Gonzalez-Latapi
- Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON M5T2S8, Canada;
| | - Ece Bayram
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA; (E.B.); (I.L.)
| | - Irene Litvan
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA; (E.B.); (I.L.)
| | - Connie Marras
- Edmond J. Safra Program in Parkinson’s Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON M5T2S8, Canada;
- Correspondence:
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Kee TR, Espinoza Gonzalez P, Wehinger JL, Bukhari MZ, Ermekbaeva A, Sista A, Kotsiviras P, Liu T, Kang DE, Woo JAA. Mitochondrial CHCHD2: Disease-Associated Mutations, Physiological Functions, and Current Animal Models. Front Aging Neurosci 2021; 13:660843. [PMID: 33967741 PMCID: PMC8100248 DOI: 10.3389/fnagi.2021.660843] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 12/19/2022] Open
Abstract
Rare mutations in the mitochondrial protein coiled-coil-helix-coiled-coil-helix domain containing 2 (CHCHD2) are associated with Parkinson's disease (PD) and other Lewy body disorders. CHCHD2 is a bi-organellar mediator of oxidative phosphorylation, playing crucial roles in regulating electron flow in the mitochondrial electron transport chain and acting as a nuclear transcription factor for a cytochrome c oxidase subunit (COX4I2) and itself in response to hypoxic stress. CHCHD2 also regulates cell migration and differentiation, mitochondrial cristae structure, and apoptosis. In this review, we summarize the known disease-associated mutations of CHCHD2 in Asian and Caucasian populations, the physiological functions of CHCHD2, how CHCHD2 mutations contribute to α-synuclein pathology, and current animal models of CHCHD2. Further, we discuss the necessity of continued investigation into the divergent functions of CHCHD2 and CHCHD10 to determine how mutations in these similar mitochondrial proteins contribute to different neurodegenerative diseases.
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Affiliation(s)
- Teresa R Kee
- USF Health Byrd Alzheimer's Center and Research Institute, Tampa, FL, United States.,Department of Molecular Pharmacology and Physiology, USF Health Morsani College of Medicine, Tampa, FL, United States
| | | | - Jessica L Wehinger
- USF Health Byrd Alzheimer's Center and Research Institute, Tampa, FL, United States
| | - Mohammed Zaheen Bukhari
- USF Health Byrd Alzheimer's Center and Research Institute, Tampa, FL, United States.,Department of Molecular Medicine, USF Health Morsani College of Medicine, Tampa, FL, United States
| | - Aizara Ermekbaeva
- USF Health Byrd Alzheimer's Center and Research Institute, Tampa, FL, United States
| | - Apoorva Sista
- USF Health Byrd Alzheimer's Center and Research Institute, Tampa, FL, United States
| | - Peter Kotsiviras
- USF Health Byrd Alzheimer's Center and Research Institute, Tampa, FL, United States
| | - Tian Liu
- USF Health Byrd Alzheimer's Center and Research Institute, Tampa, FL, United States.,Department of Molecular Medicine, USF Health Morsani College of Medicine, Tampa, FL, United States
| | - David E Kang
- USF Health Byrd Alzheimer's Center and Research Institute, Tampa, FL, United States.,Department of Molecular Medicine, USF Health Morsani College of Medicine, Tampa, FL, United States.,James A. Haley Veterans Administration Hospital, Tampa, FL, United States
| | - Jung-A A Woo
- USF Health Byrd Alzheimer's Center and Research Institute, Tampa, FL, United States.,Department of Molecular Pharmacology and Physiology, USF Health Morsani College of Medicine, Tampa, FL, United States
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Oxtoby NP, Leyland LA, Aksman LM, Thomas GEC, Bunting EL, Wijeratne PA, Young AL, Zarkali A, Tan MMX, Bremner FD, Keane PA, Morris HR, Schrag AE, Alexander DC, Weil RS. Sequence of clinical and neurodegeneration events in Parkinson's disease progression. Brain 2021; 144:975-988. [PMID: 33543247 PMCID: PMC8041043 DOI: 10.1093/brain/awaa461] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/05/2020] [Accepted: 10/24/2020] [Indexed: 02/07/2023] Open
Abstract
Dementia is one of the most debilitating aspects of Parkinson's disease. There are no validated biomarkers that can track Parkinson's disease progression, nor accurately identify patients who will develop dementia and when. Understanding the sequence of observable changes in Parkinson's disease in people at elevated risk for developing dementia could provide an integrated biomarker for identifying and managing individuals who will develop Parkinson's dementia. We aimed to estimate the sequence of clinical and neurodegeneration events, and variability in this sequence, using data-driven statistical modelling in two separate Parkinson's cohorts, focusing on patients at elevated risk for dementia due to their age at symptom onset. We updated a novel version of an event-based model that has only recently been extended to cope naturally with clinical data, enabling its application in Parkinson's disease for the first time. The observational cohorts included healthy control subjects and patients with Parkinson's disease, of whom those diagnosed at age 65 or older were classified as having high risk of dementia. The model estimates that Parkinson's progression in patients at elevated risk for dementia starts with classic prodromal features of Parkinson's disease (olfaction, sleep), followed by early deficits in visual cognition and increased brain iron content, followed later by a less certain ordering of neurodegeneration in the substantia nigra and cortex, neuropsychological cognitive deficits, retinal thinning in dopamine layers, and further deficits in visual cognition. Importantly, we also characterize variation in the sequence. We found consistent, cross-validated results within cohorts, and agreement between cohorts on the subset of features available in both cohorts. Our sequencing results add powerful support to the increasing body of evidence suggesting that visual processing specifically is affected early in patients with Parkinson's disease at elevated risk of dementia. This opens a route to earlier and more precise detection, as well as a more detailed understanding of the pathological mechanisms underpinning Parkinson's dementia.
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Affiliation(s)
- Neil P Oxtoby
- Centre for Medical Image Computing, Department of Computer Science and Department of Medical Physics and Biomedical Engineering, UCL, London, UK
| | | | - Leon M Aksman
- Centre for Medical Image Computing, Department of Computer Science and Department of Medical Physics and Biomedical Engineering, UCL, London, UK
| | - George E C Thomas
- Dementia Research Centre, UCL Institute of Neurology, UCL, London, UK
| | - Emma L Bunting
- Dementia Research Centre, UCL Institute of Neurology, UCL, London, UK
| | - Peter A Wijeratne
- Centre for Medical Image Computing, Department of Computer Science and Department of Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Alexandra L Young
- Centre for Medical Image Computing, Department of Computer Science and Department of Medical Physics and Biomedical Engineering, UCL, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Angelika Zarkali
- Dementia Research Centre, UCL Institute of Neurology, UCL, London, UK
| | - Manuela M X Tan
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, UCL, London, UK
- Movement Disorders Consortium, UCL, London, UK
| | - Fion D Bremner
- Neuro-ophthalmology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK
| | - Pearse A Keane
- Institute of Ophthalmology, UCL, London, UK
- Moorfields Eye Hospital, London, UK
| | - Huw R Morris
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, UCL, London, UK
- Movement Disorders Consortium, UCL, London, UK
| | - Anette E Schrag
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, UCL, London, UK
- Movement Disorders Consortium, UCL, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science and Department of Medical Physics and Biomedical Engineering, UCL, London, UK
| | - Rimona S Weil
- Dementia Research Centre, UCL Institute of Neurology, UCL, London, UK
- Movement Disorders Consortium, UCL, London, UK
- The Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, UCL, London, UK
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66
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Amyloid related cerebral microbleed and plasma Aβ40 are associated with cognitive decline in Parkinson's disease. Sci Rep 2021; 11:7115. [PMID: 33782518 PMCID: PMC8007804 DOI: 10.1038/s41598-021-86617-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/25/2021] [Indexed: 02/01/2023] Open
Abstract
Cerebral microbleeds (MBs) have been found in patients with cognitive decline. We aimed to examine whether MBs are associated with motor or cognitive decline in patients with Parkinson’s disease (PD). We enrolled 135 PD patients and 34 healthy controls. All participants underwent brain MRI and plasma biomarker assays, including tau, Aβ42, Aβ40, and α-synuclein. PD with dementia (PDD) was operationally defined as Mini-Mental State Examination (MMSE) score < 26 and advanced motor stage was defined as Hoehn-Yahr stage ≥ 3 during “on” status. The association between MBs and disease severity was examined using multivariate logistic regression models. More lobar MBs were observed in PD patients than controls (20.7% vs. 3.3%, p = 0.031). PDD patients had more lobar MBs (33.3% vs. 15.6%, p = 0.034), more white matter hyperintensity (p = 0.021) and reduced hippocampal volume (p = 0.001) than PD with normal cognition. The presence of lobar MB (odds ratio = 2.83 [95% confidence interval 1.04–7.70], p = 0.042) and severe white matter hyperintensity (3.29 [1.21–8.96], p = 0.020) was independently associated with PDD after adjusting for vascular risk factors and other confounders. Furthermore, plasma Aβ40 levels were associated the MMSE score (p = 0.004) after adjusting for age and sex. Our findings demonstrated that lobar MBs, reduced hippocampal volume, and elevated plasma Aβ40 levels are associated with PDD.
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Lin CH, Tsai PI, Lin HY, Hattori N, Funayama M, Jeon B, Sato K, Abe K, Mukai Y, Takahashi Y, Li Y, Nishioka K, Yoshino H, Daida K, Chen ML, Cheng J, Huang CY, Tzeng SR, Wu YS, Lai HJ, Tsai HH, Yen RF, Lee NC, Lo WC, Hung YC, Chan CC, Ke YC, Chao CC, Hsieh ST, Farrer M, Wu RM. Mitochondrial UQCRC1 mutations cause autosomal dominant parkinsonism with polyneuropathy. Brain 2021; 143:3352-3373. [PMID: 33141179 PMCID: PMC7719032 DOI: 10.1093/brain/awaa279] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/25/2020] [Accepted: 07/12/2020] [Indexed: 12/14/2022] Open
Abstract
Parkinson's disease is a neurodegenerative disorder with a multifactorial aetiology. Nevertheless, the genetic predisposition in many families with multi-incidence disease remains unknown. This study aimed to identify novel genes that cause familial Parkinson's disease. Whole exome sequencing was performed in three affected members of the index family with a late-onset autosomal-dominant parkinsonism and polyneuropathy. We identified a novel heterozygous substitution c.941A>C (p.Tyr314Ser) in the mitochondrial ubiquinol-cytochrome c reductase core protein 1 (UQCRC1) gene, which co-segregates with disease within the family. Additional analysis of 699 unrelated Parkinson's disease probands with autosomal-dominant Parkinson's disease and 1934 patients with sporadic Parkinson's disease revealed another two variants in UQCRC1 in the probands with familial Parkinson's disease, c.931A>C (p.Ile311Leu) and an allele with concomitant splicing mutation (c.70-1G>A) and a frameshift insertion (c.73_74insG, p.Ala25Glyfs*27). All substitutions were absent in 1077 controls and the Taiwan Biobank exome database from healthy participants (n = 1517 exomes). We then assayed the pathogenicity of the identified rare variants using CRISPR/Cas9-based knock-in human dopaminergic SH-SY5Y cell lines, Drosophila and mouse models. Mutant UQCRC1 expression leads to neurite degeneration and mitochondrial respiratory chain dysfunction in SH-SY5Y cells. UQCRC1 p.Tyr314Ser knock-in Drosophila and mouse models exhibit age-dependent locomotor defects, dopaminergic neuronal loss, peripheral neuropathy, impaired respiratory chain complex III activity and aberrant mitochondrial ultrastructures in nigral neurons. Furthermore, intraperitoneal injection of levodopa could significantly improve the motor dysfunction in UQCRC1 p.Tyr314Ser mutant knock-in mice. Taken together, our in vitro and in vivo studies support the functional pathogenicity of rare UQCRC1 variants in familial parkinsonism. Our findings expand an additional link of mitochondrial complex III dysfunction in Parkinson's disease.
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Affiliation(s)
- Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-I Tsai
- Department of Biochemistry and Biophysics, University of California San Francisco, USA
| | - Han-Yi Lin
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Manabu Funayama
- Research Institute for Diseases of Old Age, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Beomseok Jeon
- Department of Neurology, Movement Disorder Center, Seoul National University Hospital, Parkinson Study Group, Seoul National University College of Medicine, Seoul, Korea
| | - Kota Sato
- Department of Neurology, Okayama University Medical School, Okayama, Japan
| | - Koji Abe
- Department of Neurology, Okayama University Medical School, Okayama, Japan
| | - Yohei Mukai
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Yuanzhe Li
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenya Nishioka
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyo Yoshino
- Research Institute for Diseases of Old Age, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kensuke Daida
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Meng-Ling Chen
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jay Cheng
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Yen Huang
- The first core laboratory, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shiou-Ru Tzeng
- Institute of Biochemistry and Molecular Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Sheng Wu
- Electron Microscope Laboratory of Tzong Jwo Jang, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Hsing-Jung Lai
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ni-Chung Lee
- Department of Medical Genetics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chun Lo
- Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Chien Hung
- Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Chiang Chan
- Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ci Ke
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Chao Chao
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sung-Tsang Hsieh
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Anatomy and Cell Biology, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Matthew Farrer
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.,Center for Applied Neurogenetics, University of British Columbia, Canada
| | - Ruey-Meei Wu
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Nasamran CA, Sachan ANS, Mott J, Kuras YI, Scherzer CR, Study HB, Ricciardelli E, Jepsen K, Edland SD, Fisch KM, Desplats P. Differential blood DNA methylation across Lewy body dementias. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12156. [PMID: 33665346 PMCID: PMC7896631 DOI: 10.1002/dad2.12156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/29/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) are characterized by cognitive alterations, visual hallucinations, and motor impairment. Diagnosis is based on type and timing of clinical manifestations; however, determination of clinical subtypes is challenging. The utility of blood DNA methylation as a biomarker for Lewy body disorders (LBD) is mostly unexplored. METHODS We performed a cross-sectional analysis of blood methylation in 42 DLB and 50 PDD cases applying linear models to compare groups and logistic least absolute shrinkage and selection operator regression to explore the discriminant power of methylation signals. RESULTS DLB blood shows differential methylation compared to PDD. Some methylation changes associate with core features of LBD. Sets of probes show high predictive value to discriminate between variants. DISCUSSION Our study is the first to explore LBD blood methylation. Despite overlapping clinical presentation, we detected differential epigenetic signatures that, if confirmed in independent cohorts, could be developed into useful biomarkers.
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Affiliation(s)
- Chanond A. Nasamran
- Center for Computational Biology & BioinformaticsDepartment of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Anubhav Nikunj Singh Sachan
- Division of Biostatistics, Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Jennifer Mott
- Department of Neurosciences, School of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Yuliya I. Kuras
- Center for Advanced Parkinson Research and Precision Neurology Program, Harvard Medical SchoolBrigham & Women's HospitalBostonMassachusettsUSA
| | - Clemens R. Scherzer
- Center for Advanced Parkinson Research and Precision Neurology Program, Harvard Medical SchoolBrigham & Women's HospitalBostonMassachusettsUSA
| | | | - Eugenia Ricciardelli
- Genomics CenterInstitute for Genomics MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Kristen Jepsen
- Genomics CenterInstitute for Genomics MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Steven D. Edland
- Department of Neurosciences, School of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Kathleen M. Fisch
- Center for Computational Biology & BioinformaticsDepartment of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Paula Desplats
- Department of Neurosciences, School of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of Pathology, School of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
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69
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Gallay MN, Moser D, Magara AE, Haufler F, Jeanmonod D. Bilateral MR-Guided Focused Ultrasound Pallidothalamic Tractotomy for Parkinson's Disease With 1-Year Follow-Up. Front Neurol 2021; 12:601153. [PMID: 33633664 PMCID: PMC7900542 DOI: 10.3389/fneur.2021.601153] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/05/2021] [Indexed: 11/19/2022] Open
Abstract
Objective: Bilateral stereotactic neurosurgery for advanced Parkinson's disease (PD) has a long history beginning in the late 1940s. In view of improved lesioning accuracy and reduced bleeding risk and in spite of long-standing caveats about bilateral approaches, there is a need to investigate bilateral MR-guided focused ultrasound (MRgFUS) interventions. We hereby present the clinical results of bilateral pallidothalamic tractotomy (PTT), i.e., targeting of pallidal efferent fibers below the thalamus at the level of Forel's field H1, followed for 1 year after operation of the second side. Methods: Ten patients suffering from chronic and therapy-resistant PD having received bilateral PTT were followed for 1 year after operation of the second side. The primary endpoints included the Unified Parkinson's Disease Rating Scale (UPDRS) scores in on- and off-medication states, dyskinesias, dystonia, sleep disturbances, pain, reduction in drug intake, and assessment by the patient of her/his global symptom relief as well as tremor control. Results: The time frame between baseline UPDRS score and 1 year after the second side was 36 ± 15 months. The total UPDRS score off-medication at 1 year after the second PTT was reduced by 52% compared to that at baseline on-medication (p < 0.007). Percentage reductions of the mean scores comparing 1 year off- with baseline on-medication examinations were 91% for tremor (p = 0.006), 67% for distal rigidity (p = 0.006), and 54% for distal hypobradykinesia (p = 0.01). Gait and postural instability were globally unchanged to baseline (13% improvement of the mean, p = 0.67, and 5.3% mean reduction, p = 0.83). Speech difficulties, namely, hypophonia, tachyphemia, and initiation of speech, were increased by 58% (p = 0.06). Dyskinesias were suppressed in four over four, dystonia in four over five, and sleep disorders in three over four patients. There was 89% pain reduction. Mean L-Dopa intake was reduced from 690 ± 250 to 110 ± 190. Conclusions: Our results suggest an efficiency of bilateral PTT in controlling tremor, distal rigidity, distal hypobradykinesia, dyskinesias, dystonia, and pain when compared to best medical treatment at baseline. Larger series are of course needed.
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Affiliation(s)
- Marc N Gallay
- SoniModul, Center for Ultrasound Functional Neurosurgery, Solothurn, Switzerland
| | - David Moser
- SoniModul, Center for Ultrasound Functional Neurosurgery, Solothurn, Switzerland
| | - Anouk E Magara
- SoniModul, Center for Ultrasound Functional Neurosurgery, Solothurn, Switzerland.,Praxisgemeinschaft für Neurologie, Bern, Switzerland
| | - Fabio Haufler
- ETH Zürich, Department of Management, Technology, and Economics, Zurich, Switzerland
| | - Daniel Jeanmonod
- SoniModul, Center for Ultrasound Functional Neurosurgery, Solothurn, Switzerland
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70
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Unda SR, Antoniazzi AM, Altschul DJ, Marongiu R. Peripheral Leukocytosis Predicts Cognitive Decline but Not Behavioral Disturbances: A Nationwide Study of Alzheimer's and Parkinson's Disease Patients. Dement Geriatr Cogn Disord 2021; 50:143-152. [PMID: 34058741 PMCID: PMC8376803 DOI: 10.1159/000516340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/30/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Peripheral and central nervous system inflammation have been linked to the classic symptoms of Parkinson's disease (PD) and Alzheimer's disease (AD). However, it remains unclear whether the analysis of routine systemic inflammatory markers could represent a useful prediction tool to identify clinical subtypes in patients with Parkinson's and Alzheimer's at higher risk of dementia-associated symptoms, such as behavioral and psychological symptoms of dementia (BPSD). METHODS We performed a multivariate logistic regression using the 2016 and 2017 National Inpatient Sample with International Classification of Diseases 10th edition codes to assess if pro-inflammatory white blood cells (WBCs) anomalies correlate with dementia and BPSD in patients with these disorders. RESULTS We found that leukocytosis was the most common WBC inflammatory marker identified in 3.9% of Alzheimer's and 3.3% Parkinson's patients. Leukocytosis was also found to be an independent risk factor for Parkinson's dementia. Multivariate analysis of both cohorts showed that leukocytosis is significantly decreased in patients with BPSD compared to patients without BPSD. CONCLUSIONS These results suggest a link between leukocytosis and the pathophysiology of cognitive dysfunction in both PD and AD. A better understanding of the role of systemic neuroinflammation on these devastating neurodegenerative disorders may facilitate the development of cost-effective blood biomarkers for patient's early diagnosis and more accurate prognosis.
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Affiliation(s)
- Santiago R. Unda
- Department of Neurological Surgery, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | - David J. Altschul
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Roberta Marongiu
- Department of Neurological Surgery, Weill Cornell Medicine, Cornell University, New York, NY, USA
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71
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Kong WL, Huang Y, Qian E, Morris MJ. Constipation and sleep behaviour disorder associate with processing speed and attention in males with Parkinson's disease over five years follow-up. Sci Rep 2020; 10:19014. [PMID: 33149217 PMCID: PMC7643116 DOI: 10.1038/s41598-020-75800-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023] Open
Abstract
Constipation and REM sleep behaviour disorder (RBD) are the earliest non-motor manifestations of Parkinson's disease (PD). Among non-motor symptoms of PD, it is unclear whether constipation and RBD at early stages of PD are related to cognitive outcomes at later stages. Herein, this study aims to investigate whether the presence of constipation and RBD have an impact on future cognitive outcomes in PD. Access to Parkinson's Progression Markers Initiative (PPMI) database of 360 PD patients with longitudinal observation was requested. Constipation, probable RBD (pRBD) and neuropsychological task scores of PD patients were assessed at baseline and after 5 years. Linear mixed-effects modelling, controlling for gender, age, years of education and LEDD was used to evaluate the association between baseline constipation, pRBD and cognitive performance on follow-up. Gender differences in neuropsychological test performances were found, with men having worse global cognition, speed-attention processing, verbal learning and memory than women at early stages of the disease. We found constipation and pRBD are strongly associated with future decline in some cognitive measures among PD patients, more prominently in men. Our data suggest that early assessment of pRBD and constipation may allow better understanding of the progression of cognitive changes in later phases of PD.
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Affiliation(s)
- Wee Lee Kong
- Department of Pharmacology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052 Australia
| | - Yue Huang
- Department of Pharmacology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052 Australia
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100071 China
| | - Elizabeth Qian
- Department of Pharmacology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052 Australia
| | - Margaret J. Morris
- Department of Pharmacology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052 Australia
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72
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Malar DS, Prasanth MI, Brimson JM, Sharika R, Sivamaruthi BS, Chaiyasut C, Tencomnao T. Neuroprotective Properties of Green Tea ( Camellia sinensis) in Parkinson's Disease: A Review. Molecules 2020; 25:E3926. [PMID: 32867388 PMCID: PMC7504552 DOI: 10.3390/molecules25173926] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 12/21/2022] Open
Abstract
Neurodegenerative disease is a collective term given for the clinical condition, which results in progressive degeneration of neurons and the loss of functions associated with the affected brain region. Apart from the increase in age, neurodegenerative diseases are also partly affected by diet and lifestyle practices. Parkinson's disease (PD) is a slow onset neurodegenerative disorder and the second most common neurodegenerative disease, which affects the motor system. Although there is no prescribed treatment method to prevent and cure PD, clinical procedures help manage the disease symptoms. Green tea polyphenols are known for several health benefits, including antioxidant, anti-inflammatory, and neuroprotective activity. The current manuscript summarizes the possible mechanisms of neuroprotective potential of green tea with a special focus on PD. Studies have suggested that the consumption of green tea protects against free-radicals, inflammation, and neuro-damages. Several in vivo studies aid in understanding the overall mechanism of green tea. However, the same dose may not be sufficient in humans to elicit similar effects due to complex physiological, social, and cultural development. Future research focused on more clinical trials could identify an optimum dose that could impart maximum health benefits to impart neuroprotection in PD.
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Affiliation(s)
- Dicson Sheeja Malar
- Age-Related Inflammation and Degeneration Research Unit, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (D.S.M.); (M.I.P.); (J.M.B.)
| | - Mani Iyer Prasanth
- Age-Related Inflammation and Degeneration Research Unit, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (D.S.M.); (M.I.P.); (J.M.B.)
| | - James Michael Brimson
- Age-Related Inflammation and Degeneration Research Unit, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (D.S.M.); (M.I.P.); (J.M.B.)
| | - Rajasekharan Sharika
- 309, Vrinda, 10th Cross, Railway Layout, Vijayanagar 2nd Stage, Mysuru, Karnataka 570016, India;
| | - Bhagavathi Sundaram Sivamaruthi
- Innovation Center for Holistic Health, Nutraceuticals and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (B.S.S.); (C.C.)
| | - Chaiyavat Chaiyasut
- Innovation Center for Holistic Health, Nutraceuticals and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (B.S.S.); (C.C.)
| | - Tewin Tencomnao
- Age-Related Inflammation and Degeneration Research Unit, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (D.S.M.); (M.I.P.); (J.M.B.)
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Parkinson's Disease-Cognitive Rating Scale for Evaluating Cognitive Impairment in Parkinson's Disease: A Systematic Review. Brain Sci 2020; 10:brainsci10090588. [PMID: 32854426 PMCID: PMC7565957 DOI: 10.3390/brainsci10090588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 12/12/2022] Open
Abstract
The aim of the present systematic review was to examine the evidence on the accuracy and psychometric properties of the Parkinson’s Disease-Cognitive Rating Scale (PD-CRS) for evaluating the presence of cognitive impairment in patients with Parkinson’s disease (PD) as well as to highlight the quality and quantity of research available on the use of the PD-CRS in this population. We searched four databases from inception until July 2020. Eight studies, published between 2008 and 2020, met the inclusion criteria: One cross-sectional study in which participants were assessed with the index test (PD-CRS) and a reference standard diagnostic assessment, in accordance with the Level II criteria of the International Parkinson and Movement Disorder Society (MDS); one case-control study comparing the PD-CRS to an extensive battery of tests (i.e., MDS Level II diagnosis); and six studies comparing the PD-CRS to other short cognitive batteries. In patients with Parkinson’s disease, the PD-CRS test provides information about cortical and sub-cortical cognitive functions. Even if it demonstrated good psychometric properties, the results regarding the optimal threshold for detecting mild cognitive impairment and dementia in PD are somewhat inconsistent. Further cross-sectional studies are necessary to examine the optimum cut-off score for detecting cognitive dysfunction in PD patients.
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74
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Chou CH, Feng IJ, Chen YC, Chen JH, Lin HJ, Wang JJ, Hsu CC, Huang CC. Risk of Dementia in Diabetic Patients with Hyperglycemic Crisis: A Nationwide Taiwanese Population-Based Cohort Study. Neuroepidemiology 2020; 54:419-426. [PMID: 32841952 DOI: 10.1159/000509754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 06/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A hyperglycemic crisis episode (HCE) signifies poor control of diabetes and may increase the risk of dementia via microvascular and macrovascular injuries. OBJECTIVES We conducted this study to clarify this issue, which remains unclear. METHODS Using the Taiwan National Health Insurance Database, we identified 9,466 diabetic patients with HCE and the identical number of diabetic patients without HCE who were matched by age and sex for this nationwide population-based cohort study. The risk of dementia was compared between the 2 cohorts by following up until 2014. Investigation of independent predictors of dementia was also done. RESULTS In the overall analysis, the risk of dementia between the 2 cohorts was not different. However, stratified analyses showed that patients with HCE had a higher risk of subsequent dementia in the age subgroup of 45-54 and 55-64 years (adjusted odds ratio [AOR]: 2.4, 95% confidence interval [CI]: 1.6-3.6, and AOR: 1.2, 95% CI: 1.0-1.5, respectively). In the overall analysis, older age, female sex, ≥3 HCEs, hypertension, hyperlipidemia, depression, cerebrovascular disease, Parkinson's disease, and head injury were independent predictors. CONCLUSIONS HCE increased the risk of dementia in diabetic patients aged 45-64 years. Dementia was predicted by ≥3 HCEs. Prevention of recurrent HCE, control of comorbidities, and close follow-up of cognitive decline and dementia are suggested in patients with HCE.
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Affiliation(s)
- Chih-Ho Chou
- Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - I-Jung Feng
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Jiann-Hwa Chen
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan.,Fu Jen Catholic University School of Medicine, Taipei, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan, .,Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan, .,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan,
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75
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Simon-Gozalbo A, Rodriguez-Blazquez C, Forjaz MJ, Martinez-Martin P. Clinical Characterization of Parkinson's Disease Patients With Cognitive Impairment. Front Neurol 2020; 11:731. [PMID: 32849203 PMCID: PMC7417300 DOI: 10.3389/fneur.2020.00731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/15/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Cognitive impairment is one of the most frequent and disabling non-motor symptoms in Parkinson disease (PD) and encompasses a continuum from mild cognitive impairment (PD-MCI) to dementia (PDD). The risk factors associated with them are not completely elucidated. Objective: To characterize the presence and clinical presentation of PD-MCI and PDD in patients with idiopathic PD, examining motor and non-motor features and determining factors associated with cognitive impairment. Methods: Multicenter, cross-sectional study in 298 PD patients who underwent clinical [Hoehn and Yahr (HY) staging and Clinical Impression of Severity Index for Parkinson Disease], neurological [Scales for Outcomes in Parkinson's Disease (SCOPA)-Motor], neuropsychological (Mini Mental State Examination, SCOPA-Cognition, Frontal Assessment Battery and Clinical Dementia Rating Scale), neuropsychiatric [SCOPA-Psychiatric complications, SCOPA-Psychosocial (SCOPA-PS), and Hospital Anxiety and Depression Scale (HADS)], and health-related quality of life [Parkinson Disease Questionnaire for quality of life (PDQ-8)] assessment. Movement Disorders Society criteria were applied to classify patients as normal cognition (NC), PD-MCI, and PDD. The association between variables was explored using multivariate binary and multinomial logistic regression models. Results: Seventy-two patients (24.2%) were classified as NC, 82 (27.5%) as PD-MCI, and 144 (48.3%) as PDD. These last two groups reported more psychosocial problems related with the disease (mean SCOPA-PS, 16.27 and 10.39, respectively), compared with NC (7.28) and lower quality-of-life outcomes (PDQ-8 48.98 and 28.42, respectively) compared to NC (19.05). The logistic regression analysis showed that both cognitive impaired groups had a more severe stage of PD measured by HY [odds ratio (OR) for MCI-PD, 2.45; 95% confidence interval (CI), 1.22-4.90; OR for PDD 2.64; 95% CI, 1.17-5.98]. Specifically, age (OR, 1.30; 95% CI, 1.16-1.47), years of education (OR, 0.91; 95% CI, 0.83-0.99), disease duration (OR, 1.19; 95% CI, 1.07-1.32), HADS-D (OR, 1.20; 95% CI, 1.06-1.35), and hallucinations (OR, 2.98; 95% CI, 1.16-7.69) were related to PDD. Conclusions: Cognitive impairment in PD is associated with more severe disease stage, resulting in a global, neuropsychiatric, psychosocial, and quality-of-life deterioration. This study provides a better understanding of the great impact that cognitive impairment has within the natural history of PD and its relationship with the rest of motor and non-motor symptoms in the disease.
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Affiliation(s)
- Ana Simon-Gozalbo
- Doctorate Program in Health Sciences, University of Alcala, Alcala de Henares, Spain
| | | | - Maria J Forjaz
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
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Intranasal insulin ameliorates cognitive impairment in a rat model of Parkinson's disease through Akt/GSK3β signaling pathway. Life Sci 2020; 259:118159. [PMID: 32763288 DOI: 10.1016/j.lfs.2020.118159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/22/2022]
Abstract
AIMS Parkinson's disease dementia (PDD) is one of the most common non-motor symptoms of advanced Parkinson's disease (PD). This study aimed to determine whether intranasal insulin has protective effects on cognition in the rat PD model induced by 6-hydroxylase dopamine (6-OHDA) through the insulin signaling pathway. MATERIALS AND METHODS The rats were given intranasal insulin administration for six weeks after unilateral medial forebrain bundle (MFB) injection of 6-OHDA. Then a series of cognitive-behavioral tests, immunofluorescence, and immunoblotting was performed on the rats. KEY FINDINGS The results demonstrated that the injection of 6-OHDA in the unilateral MFB damaged working memory and long-term habituation of rats in the T-maze rewarded alternation test and hole-board test. Besides, rats with unilateral 6-OHDA injury performed poorly in terms of escape latency and average speed during the hidden platform training phase rather than in the probe trial of the Morris Water Maze (MWM) test. Immunofluorescence results showed that unilateral 6-OHDA injury in MFB led to the massive death of ipsilateral-substantia nigra (SN) tyrosine hydroxylase (TH)-positive neurons. Western blot results further indicated that 6-OHDA-induced necrosis of ipsilateral-SN dopaminergic neurons reduced the levels of p-Akt (Ser473) and p-GSK3β (Ser9) in the ipsilateral-hippocampus. SIGNIFICANCE These findings provide a solid evidence base for the relationship between PD cognitive impairment and insulin signaling pathways.
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77
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Gonçalves AR, Mendes A, Vila-Chã N, Damásio J, Fernandes J, Cavaco SM. Past appendectomy may be related to early cognitive dysfunction in Parkinson's disease. Neurol Sci 2020; 42:123-130. [PMID: 32529319 DOI: 10.1007/s10072-020-04507-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/30/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The vermiform appendix is a potential site of initiation of Parkinson's disease (PD) pathology. We hypothesized that the appendectomy earlier in life may alter the clinical expression of PD. OBJECTIVE To explore the effects of appendectomy prior to onset of PD motor symptoms on patients' symptoms, in particular on cognitive dysfunction. METHODS Two hundred and sixty-two consecutive PD patients were asked about past history of appendectomy and underwent an evaluation, which included the Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn & Yahr scale (H&Y), Schwab & England Independence Scale (S&E), Dementia Rating Scale-2 (DRS-2), Apathy Evaluation Scale, Hospital Anxiety and Depression Scale, and Brief Smell Identification Test. Motor symptoms were evaluated in OFF and ON states. Non-parametric group comparisons and logistic regressions were used for data analyses. RESULTS Thirty-one patients (11.8%) had history of appendectomy prior to PD onset. These patients had more severe motor symptoms (UPDRS-III and H&Y) and lower functional independence (S&E) in ON and had higher frequency of cognitive dysfunction (DRS-2 Initiation/Perseveration, Conceptualization, and Memory subscales) (p < 0.05). The association between history of appendectomy and cognitive dysfunction was evident only in patients with late onset PD (≥ 55 years) and with disease duration ≤ 5 years. History of appendectomy remained statistically associated with impairment on DRS-2 Conceptualization and Memory subscales, when demographic and clinical variables were considered. CONCLUSION History of appendectomy appears to alter the clinical expression of late onset PD, with early cognitive impairment, more severe motor symptoms in ON, and poorer functional independence under anti-parkinsonian medication.
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Affiliation(s)
- Alexandra R Gonçalves
- Department of Neurology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal. .,Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Alexandre Mendes
- Department of Neurology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - Nuno Vila-Chã
- Department of Neurology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Joana Damásio
- Department of Neurology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal
| | - Joana Fernandes
- DEFI, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Sara M Cavaco
- Department of Neurology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
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Qu S, Meng X, Liu Y, Zhang X, Zhang Y. Ginsenoside Rb1 prevents MPTP-induced changes in hippocampal memory via regulation of the α-synuclein/PSD-95 pathway. Aging (Albany NY) 2020; 11:1934-1964. [PMID: 30958793 PMCID: PMC6503885 DOI: 10.18632/aging.101884] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/20/2019] [Indexed: 12/12/2022]
Abstract
Memory deficiency is a common non-motor symptom of Parkinson’s disease (PD), and conventionally, α-synuclein is considered to be an important biomarker for both motor and cognitive characteristics attributed to PD. However, the role of physiological α-synuclein in cognitive impairment remains undetermined. Ginsenoside Rb1 has been shown to protect dopaminergic neurons (DA) from death and inhibit α-synuclein fibrillation and toxicity in vitro. Our recent study also revealed that ginsenoside Rb1 ameliorates motor deficits and prevents DA neuron death via upregulating glutamate transporter GLT-1 in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse model of PD. Whether Rb1 can improve memory deficiency and the underlying mechanism is still unknown. In this study, we found that Rb1 can prevent the spatial learning and memory deficits, increase long-term potentiation (LTP) and hippocampal glutamatergic transmission in the MPTP mouse model. The underlying neuroprotective mechanism of Rb1-improved synaptic plasticity involves Rb1 promoting hippocampal CA3 α-synuclein expression, restoring the glutamate in the CA3-schaffer collateral-CA1 pathway, and sequentially increasing postsynaptic density-95 (PSD-95) expression. Thus, we provide evidence that Rb1 modulates memory function, synaptic plasticity, and excitatory transmission via the trans-synaptic α-synuclein/PSD-95 pathway. Our findings suggest that Rb1 may serve as a functional drug in treating the memory deficiency in PD.
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Affiliation(s)
- Shaogang Qu
- Central Laboratory and Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, China
| | - Xingjun Meng
- Central Laboratory and Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, China
| | - Yan Liu
- Department of Traditional Chinese Medicine, Medical College, Xiamen University, Xiamen, China
| | - Xiuping Zhang
- Teaching Center of Experimental Medicine, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yunlong Zhang
- Key Laboratory of Neuroscience, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China.,Shenzhen Research Institute of Xiamen University, Shenzhen, China
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79
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Qin B, Yang MX, Gao W, Zhang JD, Zhao LB, Qin HX, Chen H. Voxel-wise meta-analysis of structural changes in gray matter of Parkinson's disease patients with mild cognitive impairment. ACTA ACUST UNITED AC 2020; 53:e9275. [PMID: 32428131 PMCID: PMC7266500 DOI: 10.1590/1414-431x20209275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/21/2020] [Indexed: 11/25/2022]
Abstract
Evidence from previous voxel-based morphometry (VBM) studies indicates that widespread brain regions are involved in Parkinson’s disease with mild cognitive impairment (PD-MCI). However, the spatial localization reported for gray matter (GM) abnormalities is heterogeneous. The aim of the present study was to quantitatively integrate studies on GM abnormalities observed in PD-MCI in order to determine whether a pattern exists. Eligible whole-brain VBM studies were identified by a systematic search of articles in PubMed and EMBASE databases spanning from 1995 to January 1, 2019. A meta-analysis was performed to investigate regional GM abnormalities in PD-MCI. The anisotropic effect size version of seed-based d mapping (AES-SDM) meta-analysis was conducted to explore the GMV differences of PD-MCI compared with PD patients with normal cognitive function (PD-NC). A total of 12 studies comprising 243 PD-MCI patients and 326 PD-NC were included in the meta-analysis. PD-MCI patients showed a robust GM decrease in the left insula and left superior temporal gyrus. Moreover, meta-regression analysis demonstrated that age, PD duration and stage, and Unified Parkinson’s Disease Rating Scale III and Mini-Mental State Examination scores might be partly correlated with the GM abnormalities observed in PD-MCI patients. The convergent findings of this quantitative meta-analysis revealed a characteristic neuroanatomical pattern in PD-MCI. The findings provide some evidence that MCI in PD may result in the breakdown of the insula and temporal gyrus, which may serve as specific regions of interest for further investigations.
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Affiliation(s)
- B Qin
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology/Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - M X Yang
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology/Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - W Gao
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology/Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - J D Zhang
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology/Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - L B Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - H X Qin
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology/Liuzhou People's Hospital, Liuzhou, Guangxi, China
| | - H Chen
- Department of Neurology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology/Liuzhou People's Hospital, Liuzhou, Guangxi, China
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A multifaceted exercise intervention did not alter cognitive function and cerebral perfusion in individuals with Parkinson's disease. Sci Sports 2020. [DOI: 10.1016/j.scispo.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Moon S, Kahya M, Lyons KE, Pahwa R, Akinwuntan AE, Devos H. Cognitive workload during verbal abstract reasoning in Parkinson's disease: a pilot study. Int J Neurosci 2020; 131:504-510. [PMID: 32202180 DOI: 10.1080/00207454.2020.1746309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pupillary response reflects cognitive workload during processing speed, working memory, and arithmetic tasks in Parkinson's disease (PD). Abstract reasoning, a higher-order cognitive function that relates different objects, events, or thoughts in a similar manner, may also be compromised in PD. The aim of this study was to compare pupillary response as a measure of cognitive workload while completing a verbal abstract reasoning test between patients with PD and age-matched controls. METHODS Nineteen non-demented individuals with PD (66.6 ± 8.9 years) and 10 healthy controls (65.3 ± 7.3 years) were recruited. A remote eye tracker recorded the pupillary response at 60 Hz, while the participants were performing the Similarities test of Wechsler Adult Intelligence Scale-IV. Outcome measures included pupillary response, evaluated by the Index of Cognitive Activity (ICA), and behavioral responses of the Similarities test. RESULTS The PD group (scaled scores = 8.9 ± 2.2) did not show impairment in behavioral performance on Similarities test compared with healthy controls (scaled scores = 8.8 ± 2.3; p = .91). However, the PD group (ICA = .32 ± .09) demonstrated significantly greater cognitive workload during the Similarities test compared to controls (ICA = .24 ± .08; p = .03). CONCLUSIONS Non-demented individuals with PD exerted greater cognitive workload to complete a verbal abstract reasoning task despite similar behavioral performance compared to healthy controls. Clinical utilities of pupillary response to detect and monitor early impairment in higher-order executive function will be the subject of further study in the PD population.
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Affiliation(s)
- Sanghee Moon
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Melike Kahya
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly E Lyons
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rajesh Pahwa
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Abiodun E Akinwuntan
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.,Office of the Dean, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
| | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
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Cognition Deficits in Parkinson's Disease: Mechanisms and Treatment. PARKINSONS DISEASE 2020; 2020:2076942. [PMID: 32269747 PMCID: PMC7128056 DOI: 10.1155/2020/2076942] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 02/08/2020] [Accepted: 02/26/2020] [Indexed: 12/22/2022]
Abstract
Parkinson's disease (PD) is the second most common progressive neurodegenerative disorder mainly in middle-elderly population, which represents diverse nonmotor symptoms (NMS) besides such well-documented motor symptoms as bradykinesia, resting tremor, rigidity, and postural instability. With the advancement of aging trend worldwide, the global prevalence of PD is mounting up year after year. Nowadays, accumulating lines of studies have given a comprehensive and thorough coverage of motor symptoms in PD. Yet much less attention as compared has been paid to the nonmotor symptoms of PD, such as cognition deficits. Of note, a patient with PD who suffers from cognitive impairment may harbour a statistically significantly higher risk of progressing toward dementia, which negatively affects their life expectancy and daily functioning and overall lowers the global quality of life. Furthermore, it is a widely held view that cognitive dysfunction does not just occur in the late stage of PD. On the basis of numerous studies, mild cognitive impairment (MCI) is a harbinger of dementia in PD, which is observed as an intermediate state with considerable variability; some patients remain stable and some even revert to normal cognition. Considered that the timing, profile, and rate of cognitive impairment vary greatly among PD individuals, it is extremely urgent for researchers and clinicians alike to identify and predict future cognitive decline in this population. Simultaneously, early screening and canonical management of PD with cognitive deficits are very imperative to postpone the disease progression and improve the prognosis of patients. In our review, we focus on a description of cognitive decline in PD, expound emphatically the pathological mechanisms underlying cognition deficits in PD, then give a comprehensive overview of specific therapeutic strategies, and finally dissect what fresh insights may bring new exciting prospect for the subfield.
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Guo Y, Liu FT, Hou XH, Li JQ, Cao XP, Tan L, Wang J, Yu JT. Predictors of cognitive impairment in Parkinson's disease: a systematic review and meta-analysis of prospective cohort studies. J Neurol 2020; 268:2713-2722. [PMID: 32162063 DOI: 10.1007/s00415-020-09757-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Cognitive impairment is a debilitating manifestation in Parkinson's disease (PD). We sought to investigate predictors of PD-CI (PD with cognitive impairment). METHODS We systematically searched PubMed and Cochrane Library for prospective cohort studies and pooled estimates via random-effects models. Primary analyses for all types of cognitive impairments and subgroup analyses by separate outcomes were conducted. RESULTS A total of 28,009 studies were identified, of which 57 studies with 31 factors were included in the meta-analysis. In the primary analysis, 13 factors were associated with PD-CI, comprising advanced age [relative risk (RR) = 1.07, 95% confidence interval (CI) = 1.03-1.12], age at onset (RR = 4.43, 95% CI = 1.87-10.54), postural-instability-gait disorder (RR = 3.76, 95% CI = 1.36-10.40), higher Hoehn and Yahr stage (RR = 1.83, 95% CI = 1.35-2.47), higher UPDRS III score (RR = 1.04, 95% CI = 1.01-1.08), rapid eye movement sleep behavior disorder (RR = 3.72, 95% CI = 1.20-11.54), hallucinations (RR = 3.09, 95% CI = 1.61-5.93), orthostatic hypotension (RR = 2.98, 95% CI = 1.41-6.28), anxiety (RR = 2.59, 95% CI = 1.18-5.68), APOE ε2 (RR = 6.47, 95% CI = 1.29-32.53), APOE ε4 (RR = 3.04, 95% CI = 1.88-4.91), electroencephalogram theta power > median (RR = 2.93, 95% CI = 1.61-5.33), and alpha power < median (RR = 1.77, 95% CI = 1.07-2.92). In the subgroup analysis, MAPT H1/H1 genotype increased the risk of dementia in PD. Sixty-four studies were included in the systematic review, of which 12 factors were additionally correlated with PD-CI using single studies. CONCLUSIONS Advanced age, genetic variation in APOE and MAPT, gait disturbance, motor assessments, non-motor symptoms, and electroencephalogram may be promising predictors for PD-CI.
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Affiliation(s)
- Yu Guo
- Department of Neurology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, 266071, China
| | - Feng-Tao Liu
- Department of Neurology and Institute of Neurology, WHO Collaborating Center for Research and Training in Neurosciences, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Xiao-He Hou
- Department of Neurology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, 266071, China
| | - Jie-Qiong Li
- Department of Neurology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, 266071, China
| | - Xi-Peng Cao
- Department of Neurology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, 266071, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, 266071, China.
| | - Jian Wang
- Department of Neurology and Institute of Neurology, WHO Collaborating Center for Research and Training in Neurosciences, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China.
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, WHO Collaborating Center for Research and Training in Neurosciences, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China.
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Tsai CC, Lin YC, Ng SH, Chen YL, Cheng JS, Lu CS, Weng YH, Lin SH, Chen PY, Wu YM, Wang JJ. A Method for the Prediction of Clinical Outcome Using Diffusion Magnetic Resonance Imaging: Application on Parkinson's Disease. J Clin Med 2020; 9:jcm9030647. [PMID: 32121190 PMCID: PMC7141247 DOI: 10.3390/jcm9030647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 01/06/2023] Open
Abstract
Robust early prediction of clinical outcomes in Parkinson's disease (PD) is paramount for implementing appropriate management interventions. We propose a method that uses the baseline MRI, measuring diffusion parameters from multiple parcellated brain regions, to predict the 2-year clinical outcome in Parkinson's disease. Diffusion tensor imaging was obtained from 82 patients (males/females = 45/37, mean age: 60.9 ± 7.3 years, baseline and after 23.7 ± 0.7 months) using a 3T MR scanner, which was normalized and parcellated according to the Automated Anatomical Labelling template. All patients were diagnosed with probable Parkinson's disease by the National Institute of Neurological Disorders and Stroke criteria. Clinical outcome was graded using disease severity (Unified Parkinson's Disease Rating Scale and Modified Hoehn and Yahr staging), drug administration (levodopa equivalent daily dose), and quality of life (39-item PD Questionnaire). Selection and regularization of diffusion parameters, the mean diffusivity and fractional anisotropy, were performed using least absolute shrinkage and selection operator (LASSO) between baseline diffusion index and clinical outcome over 2 years. Identified features were entered into a stepwise multivariate regression model, followed by a leave-one-out/5-fold cross validation and additional blind validation using an independent dataset. The predicted Unified Parkinson's Disease Rating Scale for each individual was consistent with the observed values at blind validation (adjusted R2 0.76) by using 13 features, such as mean diffusivity in lingual, nodule lobule of cerebellum vermis and fractional anisotropy in rolandic operculum, and quadrangular lobule of cerebellum. We conclude that baseline diffusion MRI is potentially capable of predicting 2-year clinical outcomes in patients with Parkinson's disease on an individual basis.
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Affiliation(s)
- Chih-Chien Tsai
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Yu-Chun Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan 33375, Taiwan; (Y.-C.L.); (S.-H.N.); (Y.-L.C.); (Y.-M.W.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33302, Taiwan; (S.-H.L.); (P.-Y.C.)
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan 33375, Taiwan; (Y.-C.L.); (S.-H.N.); (Y.-L.C.); (Y.-M.W.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33302, Taiwan; (S.-H.L.); (P.-Y.C.)
| | - Yao-Liang Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan 33375, Taiwan; (Y.-C.L.); (S.-H.N.); (Y.-L.C.); (Y.-M.W.)
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung City 20401, Taiwan
| | - Jur-Shan Cheng
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung City 20401, Taiwan
| | - Chin-Song Lu
- Professor Lu Neurological Clinic, Taoyuan 33375, Taiwan;
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taoyuan 33375, Taiwan;
- Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 33375, Taiwan
| | - Yi-Hsin Weng
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taoyuan 33375, Taiwan;
- Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 33375, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Sung-Han Lin
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33302, Taiwan; (S.-H.L.); (P.-Y.C.)
| | - Po-Yuan Chen
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33302, Taiwan; (S.-H.L.); (P.-Y.C.)
| | - Yi-Ming Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan 33375, Taiwan; (Y.-C.L.); (S.-H.N.); (Y.-L.C.); (Y.-M.W.)
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33302, Taiwan; (S.-H.L.); (P.-Y.C.)
| | - Jiun-Jie Wang
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan;
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33302, Taiwan; (S.-H.L.); (P.-Y.C.)
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung City 20401, Taiwan
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University/Chang Gung Memorial Hospital, Linkou 33375, Taoyuan, Taiwan
- Correspondence: ; Tel.: +886-3-211-8800 (ext. 5391); Fax: +886-3-397-1936
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Leng B, Sun H, Zhao J, Liu Y, Shen T, Liu W, Liu X, Tan M, Li F, Zhang J, Li Z. Plasma exosomal prion protein levels are correlated with cognitive decline in PD patients. Neurosci Lett 2020; 723:134866. [PMID: 32109555 DOI: 10.1016/j.neulet.2020.134866] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/17/2020] [Accepted: 02/24/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Cognitive decline is a common non-motor symptom of Parkinson disease (PD), and cellular prion protein (PrPC) has been suggested to play a role in this process. This study aimed to investigate the correlation between plasma exosomal prion protein and cognitive decline in PD patients. METHOD A total of 60 participants, which included 23 PD patients without cognitive impairment (the PD-NCI group), 17 PD patients with cognitive impairment (the PD-CI group) and 20 health controls were included in this study. All participants received a complete evaluation of motor symptoms as well as non-motor symptoms, which include devaluations of cognitive function(assessed with the Montreal Cognitive Assessment (MoCA)) and their psychiatric state(assessed with the Hamilton Anxiety Scale(HAM-A) and Hamilton Depression Scale(HAMD-17)). We used an enzyme-linked immunosorbent assay (ELISA) to measure the plasma exosomal prion protein level. The exosomal marker Heat shock protein 70 (HSP 70) was used to normalize the protein level to the exosome content. RESULT In PD patients, the plasma exosomal prion protein concentration was negatively correlated with the cognitive level. The plasma exosomal prion protein concentration was significantly higher in the PD-CI group than in the control group (p < 0.05) and the PD-NCI group (p < 0.05).Multivariate regression analysis indicated that plasma exosomal prion protein levels were significantly associated with the cognitive level (t=-3.185, P = 0.001) after adjusting for age, education, disease duration, H&Y stage and MDS-UPDRS-III scores. CONCLUSION The plasma exosomal prion protein level is correlated with cognitive decline in PD patients and might be a potential biomarker for PD patients at risk for cognitive impairment.
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Affiliation(s)
- Bing Leng
- Weifang Medical University, PR China; Department of Neurology, Weihai Municipal Hospital, Weihai Clinical School of Shandong University, PR China
| | - Hairong Sun
- Department of Neurology, Weihai Municipal Hospital, Weihai Clinical School of Shandong University, PR China
| | - Junwu Zhao
- Department of Neurology, Weihai Municipal Hospital, Weihai Clinical School of Shandong University, PR China
| | - Yuanyuan Liu
- Department of Neurology, Weihai Municipal Hospital, Weihai Clinical School of Shandong University, PR China
| | - Tengqun Shen
- Department of Neurology, Weihai Municipal Hospital, Weihai Clinical School of Shandong University, PR China
| | - Wenjin Liu
- Department of Neurology, Weihai Municipal Hospital, the Affiliated Hostpital of Binzhou Medical University, PR China
| | - Xiaoxiao Liu
- Department of Neurology, Weihai Municipal Hospital, Weihai Clinical School of Shandong University, PR China
| | - Ming Tan
- Department of Neurology, Weihai Municipal Hospital, Weihai Clinical School of Shandong University, PR China
| | - Fang Li
- Department of Neurology, the First Affiliated Hospital of Jinzhou Medical University, PR China
| | - Jinbiao Zhang
- Weifang Medical University, PR China; Department of Neurology, Weihai Municipal Hospital, Weihai Clinical School of Shandong University, PR China
| | - Zhenguang Li
- Weifang Medical University, PR China; Department of Neurology, Weihai Municipal Hospital, Weihai Clinical School of Shandong University, PR China.
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Abstract
Surgery in Parkinson disease is effective for a select group of patients when optimal medical management is not sufficient. Functional neurosurgery can be used as either a salvage therapy in patients with disabling symptoms or to maintain quality of life and independence before progression to severe disability in high-functioning patients. With recent technological advancements in imaging and targeting as well as novel neuromodulation paradigms, there are numerous options for targeted brain lesions and deep brain stimulation. Surgical decision making and postoperative management in Parkinson disease therefore often requires a multidisciplinary team effort with neurology, neurosurgery, neuropsychology, and psychiatry.
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Affiliation(s)
- Kyle T Mitchell
- Duke University Movement Disorders Center, DUMC 3333, 932 Morreene Road, Durham, NC 27705, USA.
| | - Jill L Ostrem
- UCSF Movement Disorders and Neuromodulation Center, 1635 Divisadero Street Suite 520, Box 1838, San Francisco, CA 94115, USA
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Ghanta MK, Elango P, L V K S B. Current Therapeutic Strategies and Perspectives for Neuroprotection in Parkinson's Disease. Curr Pharm Des 2020; 26:4738-4746. [PMID: 32065086 DOI: 10.2174/1381612826666200217114658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/10/2020] [Indexed: 02/04/2023]
Abstract
Parkinson's disease is a progressive neurodegenerative disorder of dopaminergic striatal neurons in basal ganglia. Treatment of Parkinson's disease (PD) through dopamine replacement strategies may provide improvement in early stages and this treatment response is related to dopaminergic neuronal mass which decreases in advanced stages. This treatment failure was revealed by many studies and levodopa treatment became ineffective or toxic in chronic stages of PD. Early diagnosis and neuroprotective agents may be a suitable approach for the treatment of PD. The essentials required for early diagnosis are biomarkers. Characterising the striatal neurons, understanding the status of dopaminergic pathways in different PD stages may reveal the effects of the drugs used in the treatment. This review updates on characterisation of striatal neurons, electrophysiology of dopaminergic pathways in PD, biomarkers of PD, approaches for success of neuroprotective agents in clinical trials. The literature was collected from the articles in database of PubMed, MedLine and other available literature resources.
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Affiliation(s)
- Mohan K Ghanta
- Department of Pharmacology, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research (DU), Porur, Chennai-600116, Tamil Nadu, India
| | - P Elango
- Department of Pharmacology, Panimalar Medical College Hospital & Research Institute, Poonamallee, Chennai-600123, Tamil Nadu, India
| | - Bhaskar L V K S
- Department of Zoology, Guru Ghasidas University, Bilaspur, 495009 (CG), India
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Spencer KA, Paul J, Brown KA, Ellerbrock T, Sohlberg MM. Cognitive Rehabilitation for Individuals With Parkinson's Disease: Developing and Piloting an External Aids Treatment Program. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1-19. [PMID: 31697899 DOI: 10.1044/2019_ajslp-19-0078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Cognitive deficits are common in Parkinson's disease (PD) and can have a detrimental effect on daily activities. To date, most cognitive treatments have had an impairment-based focus with primary outcome measures of formal neuropsychological test scores. Few, if any, studies have focused on functional improvement or patient-centered goals. Method Three individuals with idiopathic PD participated in an 8-week pilot treatment program to train for the use of compensatory external aids to achieve personalized goals. Goal attainment scaling was the primary outcome measure, which was independently judged by multiple raters at baseline, postintervention, and 1 month posttreatment and analyzed via T-score analysis. Descriptive measures, including self-report and spouse-report rating scales of cognitive functioning, were employed. Results All 3 participants improved in the majority of their laboratory and home goals posttreatment, as measured by goal attainment scaling, and maintained gains for the majority of goals 1 month posttreatment. Conclusions This is the 1st known study to implement an external aids treatment program with patient-centered goals for individuals with cognitive deficits from PD. Positive outcomes were likely influenced by 3 factors: (a) a theoretically motivated focus on external aids; (b) a well-documented, systematic approach to instruction; and (c) the personalization of goals. Supplemental Material https://doi.org/10.23641/asha.10093493.
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Affiliation(s)
- Kristie A Spencer
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Jennifer Paul
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Katherine A Brown
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Taylor Ellerbrock
- Department of Speech and Hearing Sciences, University of Washington, Seattle
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Ording AG, Veres K, Horváth-Puhó E, Glymour MM, Rørth M, Henderson VW, Sørensen HT. Alzheimer’s and Parkinson’s Diseases and the Risk of Cancer: A Cohort Study. J Alzheimers Dis 2019; 72:1269-1277. [DOI: 10.3233/jad-190867] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Anne G. Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Katalin Veres
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Mikael Rørth
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Victor W. Henderson
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
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Long-term impact of subthalamic stimulation on cognitive function in patients with advanced Parkinson's disease. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2017.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Acera M, Molano A, Tijero B, Bilbao G, Lambarri I, Villoria R, Somme J, Ruiz de Gopegui E, Gabilondo I, Gomez-Esteban J. Impacto de la estimulación subtalámica a largo plazo sobre la situación cognitiva de los pacientes con enfermedad de Parkinson avanzada. Neurologia 2019; 34:573-581. [DOI: 10.1016/j.nrl.2017.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/26/2017] [Accepted: 05/11/2017] [Indexed: 11/28/2022] Open
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Svaerke K, Niemeijer M, Løkkegaard A. The Effects of Computer-Based Cognitive Rehabilitation on Working Memory in Patients with Parkinson's Disease: A Systematic Review. JOURNAL OF PARKINSONS DISEASE 2019; 10:47-57. [PMID: 31609698 DOI: 10.3233/jpd-191726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Deterioration of working memory(WM) is a common cognitive deficit in Parkinson's disease (PD), and severely influences the ability to lead an independent life. Interventions which can delay the impact of WM deficits could positively impact the independence and quality of life of patients. OBJECTIVE To evaluate effects of computer-based cognitive rehabilitation (CBCR) on WM in patients with PD. METHODS Pubmed, Embase, Psycinfo and Cochrane Library were systematically searched. Authors of included studies were contacted to detect unpublished data or articles not found by database-search. Broad selection criteria were applied because literature was expected to be limited. Studies were eligible for inclusion if they investigated the effects of CBCR on WM in a sample consisting of at least 50% PD patients, or in which the results of PD patients could be isolated. Studies were further eligible for inclusion in a planned meta-analysis if the effects of the CBCR intervention could be isolated, the CBCR intervention was compared to active or passive control groups consisting solely of PD patients, and the WM outcome measure could be isolated. RESULTS Only six studies were included despite broad inclusion criteria. Study results were heterogeneous, and the risk of bias in study methodology was either unclear or high. Two studies were eligible for meta-analysis. A meta-analysis was not performed, because these studies used different measures of WM which were not rated as equally valid and reliable. CONCLUSION Existing literature is sparse and provides insufficient evidence to conclude if CBCR benefits WM in PD patients.
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Affiliation(s)
- Katrine Svaerke
- Bispebjerg Hospital, Department of Neurology, Copenhagen, Denmark
| | - Miriam Niemeijer
- Bispebjerg Hospital, Department of Neurology, Copenhagen, Denmark
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93
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Trait Impulsivity Is Independent of Mild Cognitive Impairment in a Parkinson's Disease Cohort. PARKINSONS DISEASE 2019; 2019:2672075. [PMID: 31662842 PMCID: PMC6791270 DOI: 10.1155/2019/2672075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/07/2019] [Accepted: 09/12/2019] [Indexed: 01/16/2023]
Abstract
Introduction Patients with Parkinson's disease (PD) commonly experience cognitive deficits and some also develop impulse control disorders (ICDs); however, the relationship between impulsivity and cognitive dysfunction remains unclear. This study investigated whether trait impulsivity associates with mild cognitive impairment (MCI), or is altered in a PD patient cohort with MCI. Methods A total of 302 patients with idiopathic PD were recruited sequentially from three Australian Movement Disorder clinics. Based on cognitive scores, participants were divided into two groups, one defined as having mild cognitive impairment (PD-MCI; n = 113) and the other with normal cognitive function (PD-C; n = 189). Trait impulsivity was evaluated using the Barrett Impulsiveness Scale 11 (BIS-11). Total impulsivity scores, as well as subscale scores, were compared between PD-C and PD-MCI groups. Results The PD-MCI cohort had significantly lower scores in all cognitive domains, and mirrored expected clinical differences in medication, motor symptoms, and disease duration, when compared to the PD-C cohort. Self-reported impulsivity was not significantly different between groups, nor was there a difference within first-order subscale scores: attention (p=0.137), cognitive instability (p=0.787), self-control (p=0.503), cognitive complexity (p=0.157), motor impulsivity (p=0.559), or perseverance (p=0.734) between the PD-MCI and PD-C groups. Conclusions These findings suggest that impulsive traits and behaviors are independent of changes in cognitive state and are not altered in PD patients with mild cognitive impairment.
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94
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Weintraub D, Mamikonyan E. The Neuropsychiatry of Parkinson Disease: A Perfect Storm. Am J Geriatr Psychiatry 2019; 27:998-1018. [PMID: 31006550 PMCID: PMC7015280 DOI: 10.1016/j.jagp.2019.03.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 12/16/2022]
Abstract
Affective disorders, cognitive decline, and psychosis have long been recognized as common in Parkinson disease (PD), and other psychiatric disorders include impulse control disorders, anxiety symptoms, disorders of sleep and wakefulness, and apathy. Psychiatric aspects of PD are associated with numerous adverse outcomes, yet in spite of this and their frequent occurrence, there is incomplete understanding of epidemiology, presentation, risk factors, neural substrate, and management strategies. Psychiatric features are typically multimorbid, and there is great intra- and interindividual variability in presentation. The hallmark neuropathophysiological changes that occur in PD, plus the association between exposure to dopaminergic medications and certain psychiatric disorders, suggest a neurobiological basis for many psychiatric symptoms, although psychological factors are involved as well. There is evidence that psychiatric disorders in PD are still under-recognized and undertreated and although psychotropic medication use is common, controlled studies demonstrating efficacy and tolerability are largely lacking. Future research on neuropsychiatric complications in PD should be oriented toward determining modifiable correlates or risk factors and establishing efficacious and well-tolerated treatment strategies.
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Affiliation(s)
- Daniel Weintraub
- Perelman School of Medicine (DW, EM), University of Pennsylvania, Philadelphia; Parkinson's Disease Research, Education and Clinical Center (PADRECC) (DW), Philadelphia Veterans Affairs Medical Center, Philadelphia.
| | - Eugenia Mamikonyan
- Perelman School of Medicine (DW, EM), University of Pennsylvania, Philadelphia
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95
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Abstract
OBJECTIVE Parkinson's disease with mild cognitive impairment (PD-MCI) is a risk factor for progression to PD dementia (PDD) at a later stage of the disease. The consensus criteria of PD-MCI use a traditional test-by-test normative comparison. The aim of this study was to investigate whether a new multivariate statistical method provides a more sensitive tool for predicting dementia status at 3- and 5-year follow-ups. This method allows a formal evaluation of a patient's profile of test scores given a large aggregated database with regression-based norms. METHOD The cognitive test results of 123 newly diagnosed PD patients from a previously published longitudinal study were analyzed with three different methods. First, the PD-MCI criteria were applied in the traditional way. Second, the PD-MCI criteria were applied using the large aggregated normative database. Last, multivariate normative comparisons (MNCs) were made using the same aggregated normative database. The outcome variable was progression to dementia within 3 and 5 years. RESULTS The MNC was characterized by higher sensitivity and higher specificity in predicting progression to PDD at follow-up than the two PD-MCI criteria methods, although the difference in classification accuracy did not reach statistical significance. CONCLUSION We conclude that MNCs could allow for a more accurate prediction of PDD than the traditional PD-MCI criteria, because there are encouraging trends in both increased sensitivity and increased specificity. (JINS, 2019, 25, 678-687).
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96
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Wang Q, Liu J, Guo Y, Dong G, Zou W, Chen Z. Association between BDNF G196A (Val66Met) polymorphism and cognitive impairment in patients with Parkinson's disease: a meta-analysis. ACTA ACUST UNITED AC 2019; 52:e8443. [PMID: 31365694 PMCID: PMC6668960 DOI: 10.1590/1414-431x20198443] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/17/2019] [Indexed: 02/08/2023]
Abstract
Brain-derived neurotrophic factor (BDNF) is widely expressed in the central nervous system and prolongs the survival of dopaminergic neurons in the substantia nigra. Several studies have recently investigated the association between BDNF G196A (Val66Met), a single nucleotide polymorphism influencing cognitive processes, and cognitive impairment in Parkinson's disease (PD), but with contradictory findings. Thus, this meta-analysis was performed to clarify the possible association. Relevant studies were identified by a systematic search of PubMed, Embase, and China National Knowledge Infrastructure (CNKI) databases. The strength of the association was evaluated using crude odds ratios and 95% confidence interval. Finally, six studies involving 532 cases and 802 controls were included. Our analyses suggested the G196A (Val66Met) polymorphism was significantly associated with cognitive impairment in PD, especially in Caucasian populations. In conclusion, BDNF G196A (Val66Met) is confirmed to be a risk factor for cognitive impairment in PD.
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Affiliation(s)
- Qian Wang
- Department of Neurology, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Jianfang Liu
- Department of Neurology, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Yikun Guo
- Department of Neurology, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Guanzhong Dong
- Department of Neurology, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Wenying Zou
- Department of Neurology, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Zhuoyou Chen
- Department of Neurology, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
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97
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The role of one-carbon metabolism and homocysteine in Parkinson’s disease onset, pathology and mechanisms. Nutr Res Rev 2019; 32:218-230. [DOI: 10.1017/s0954422419000106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractParkinson’s disease (PD) is the second most common neurodegenerative disorder. It is characterised by the progressive degeneration of dopaminergic (DA) neurons. The cause of degeneration is not well understood; however, both genetics and environmental factors, such as nutrition, have been implicated in the disease process. Deficiencies in one-carbon metabolism in particular have been associated with increased risk for PD onset and progression, though the precise relationship is unclear. The aim of the present review is to determine the role of one-carbon metabolism and elevated levels of homocysteine in PD onset and pathology and to identify potential mechanisms involved. A search of PubMed, Google Scholar and Web of Science was undertaken to identify relevant human and animal studies. Case–control, prospective cohort studies, meta-analyses and non-randomised trials were included in the present review. The results from human studies indicate that polymorphisms in one-carbon metabolism may increase risk for PD development. There is an unclear role for dietary B-vitamin intake on PD onset and progression. However, dietary supplementation with B-vitamins may be beneficial for PD-affected individuals, particularly those onl-DOPA (levodopa orl-3,4-dihydroxyphenylalanine) treatment. Additionally, one-carbon metabolism generates methyl groups, and methylation capacity in PD-affected individuals is reduced. This reduced capacity has an impact on expression of disease-specific genes that may be involved in PD progression. During B-vitamin deficiency, animal studies report increased vulnerability of DA cells through increased oxidative stress and altered methylation. Nutrition, especially folates and related B-vitamins, may contribute to the onset and progression of PD by making the brain more vulnerable to damage; however, further investigation is required.
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98
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Forsyth AL, Joshi RY, Canning CG, Allen NE, Paul SS. Flexed Posture in Parkinson Disease: Associations With Nonmotor Impairments and Activity Limitations. Phys Ther 2019; 99:893-903. [PMID: 30830153 DOI: 10.1093/ptj/pzz033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/18/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND People with Parkinson disease (PD) are twice as likely to develop flexed truncal posture as the general older population. Little is known about the mechanisms responsible beyond associations with age, axial motor impairments, and disease severity. OBJECTIVE The objective was to explore: (1) the associations of the nonmotor impairments of PD with flexed posture, and (2) the relationships of flexed posture with activity limitations. DESIGN This was a cross-sectional study. METHODS Seventy people with PD participated. Posture was measured in standing as the distance between the seventh cervical vertebra and a wall. Nonmotor impairments (cognition, depression, pain, fatigue, and proprioception) and activity performance (upper limb activity, bed transfers, respiratory function, and speech volume) were variously assessed using objective measures and self-report questionnaires. Univariate and multivariate regression analyses were performed to ascertain relationships between nonmotor impairments and truncal posture, and between truncal posture and activities. RESULTS Greater disease severity, greater axial impairment, poorer spinal proprioception, greater postural fatigue, and male sex were significantly associated with flexed truncal posture. The multivariate model containing these factors in addition to age explained 30% of the variability in flexed truncal posture, with male sex and axial motor impairment continuing to make independent contributions. A significant association was found between greater flexed truncal posture and poorer upper limb activity performance and respiratory function. LIMITATIONS A limitation to this study was that participants had mild-to-moderate disease severity. CONCLUSIONS Spinal proprioception and postural fatigue were the only nonmotor impairments to make significant contributions to flexed posture. Given the negative influence of flexed posture on upper limb activity and respiratory function, interventions targeting spinal proprioception and postural awareness should be considered for people with PD who might develop flexed posture.
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Affiliation(s)
- Aimi L Forsyth
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney; and Lady Davidson Private Hospital, Sydney, Australia
| | - Riddhi Y Joshi
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
| | - Natalie E Allen
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Australia
| | - Serene S Paul
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney NSW 2141, Australia
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99
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Characterization of Motor and Non-Motor Behavioral Alterations in the Dj-1 (PARK7) Knockout Rat. J Mol Neurosci 2019; 69:298-311. [PMID: 31250274 DOI: 10.1007/s12031-019-01358-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/18/2019] [Indexed: 02/03/2023]
Abstract
Parkinson's disease is a neurodegenerative disorder that encompasses a constellation of motor and non-motor symptoms. The etiology of the disease is still poorly understood because of complex interactions between environmental and genetic risk factors. Using animal models to assess these risk factors may lead to a better understanding of disease manifestation. In this study, we assessed the Dj-1 knockout (KO) genetic rat model in a battery of motor and non-motor behaviors. We tested the Dj-1 KO rat, as well as age-matched wild-type (WT) control rats, in several sensorimotor tests at 2, 4, 7, and 13 months of age. The Dj-1-deficient rats were found to rear and groom less, and to have a shorter stride length than their WT counterparts, but to take more forelimb and hindlimb steps. In non-motor behavioral tasks, performed at several different ages, we evaluated the following: olfactory function, anxiety-like behavior, short-term memory, anhedonia, and stress coping behavior. Non-motor testing was conducted as early as 4.5 months and as late as 17 months of age. We found that Dj-1 KO animals displayed deficits in short-term spatial memory as early as 4.5 months of age during place preference testing, as well as impaired coping strategies in the forced swim test, which are consistent with a parkinsonian-like phenotype. In some instances, effects of chronic stress were evaluated in the Dj-1-deficient rats, as an initial test of an environmental challenge combined with a genetic disposition for PD. Although some of the results were mixed with differential effects across several of the behaviors, the combination of the changes we observed indicates that the Dj-1 KO rat may be a promising model for the assessment of the prodromal stage of Parkinson's disease, but further evaluation is necessary.
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100
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Kim MY, Noh Y, Son SJ, Shin S, Paik HY, Lee S, Jung YS. Effect of Cilostazol on Incident Dementia in Elderly Men and Women with Ischemic Heart Disease. J Alzheimers Dis 2019; 63:635-644. [PMID: 29660935 DOI: 10.3233/jad-170895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Ischemic heart disease (IHD) is associated with cognitive decline and may contribute to an increased risk of dementia. OBJECTIVE The goal of the present study was to investigate whether cilostazol use is associated with a lower risk of incident dementia in Asian patients with IHD, and whether these effects differed based on sex. METHODS This retrospective cohort study was performed using the Korean National Insurance Claim Data of the Health Insurance Review and Assessment Service; the duration of the study was from January 1, 2007 to December 31, 2015. The study group comprised 66,225 patients with IHD, aged >65 years, who had received cilostazol. Age- and sex-matched IHD patients without cilostazol exposure were selected as the control group. The risk of dementia was compared between the cilostazol and control groups. RESULTS Compared to the control group, total cilostazol users had a marginally significant lower risk of incident dementia. After stratification by sex, the reducing effect of cilostazol on incident dementia was significant in female participants, but not in male participants. Female patients who had cilostazol for over 2 years showed a clinically meaningful preventive effect (HR, 0.85; 95% CI, 0.82-0.88). CONCLUSIONS This study suggested that cilostazol treatment may reduce the risk of incident dementia in Korean patients with IHD. Its beneficial effect was remarkably significant in female patients who received cilostazol for over a 2-year period.
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Affiliation(s)
- Mi-Young Kim
- College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Yoojin Noh
- College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University, School of Medicine, Suwon, Republic of Korea
| | - Sooyoung Shin
- College of Pharmacy, Ajou University, Suwon, Republic of Korea.,Research Institute of Pharmaceutical Sciences and Technology, Ajou University, Suwon, Republic of Korea
| | - Hee-Young Paik
- Center for Gendered Innovations in Science and Technology Research, Seoul, Republic of Korea.,Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Sukhyang Lee
- College of Pharmacy, Ajou University, Suwon, Republic of Korea.,Research Institute of Pharmaceutical Sciences and Technology, Ajou University, Suwon, Republic of Korea
| | - Yi-Sook Jung
- College of Pharmacy, Ajou University, Suwon, Republic of Korea.,Research Institute of Pharmaceutical Sciences and Technology, Ajou University, Suwon, Republic of Korea
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