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Madhyastha TM, Askren MK, Boord P, Zhang J, Leverenz JB, Grabowski TJ. Cerebral perfusion and cortical thickness indicate cortical involvement in mild Parkinson's disease. Mov Disord 2015; 30:1893-900. [PMID: 25759166 PMCID: PMC4567553 DOI: 10.1002/mds.26128] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/28/2014] [Accepted: 11/20/2014] [Indexed: 12/22/2022] Open
Abstract
Cortical dysfunction in Parkinson's disease (PD) may be caused by disruption to ascending systems or by intrinsic cortical neuropathology. We introduce and conduct a joint analysis of metabolism and atrophy capable of identifying whether metabolic disruption occurs in mild PD without cortical atrophy, to determine the extent and spatial pattern of cortical involvement in mild PD. The design was observational, studying 23 cognitively normal participants with mild PD (mean Hoehn & Yahr stage 2) and 21 healthy controls. Cortical thickness (obtained from analysis of structural magnetic resonance imaging [MRI] with FreeSurfer) and cerebral perfusion measures (obtained from arterial spin labeling [ASL]) analyzed independently and then together in a joint multiple factorial analysis to identify spatial patterns of perfusion and cortical thickness. We identify a pattern of changes in perfusion and cortical thickness characterized by symmetric parietal cortical thinning and reduced precuneus perfusion, with relative preservation of thickness and perfusion in the anterior cingulate cortex (ACC), right prefrontal gyrus, and medial frontal gyrus. The expression of this pattern is correlated with motor system symptoms and speed of processing. A spatial pattern of joint parietal cortical thinning and disproportionate reduction in perfusion occurs in our nondemented PD sample. We found no PD-related components of reduced perfusion without cortical thinning. This suggests that PD affects the cortex itself, even when symptoms are relatively mild.
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Affiliation(s)
| | - Mary K Askren
- Department of Radiology, University of Washington, Seattle, USA
| | - Peter Boord
- Department of Radiology, University of Washington, Seattle, USA
| | - Jing Zhang
- Department of Pathology, University of Washington, Seattle, USA
| | - James B Leverenz
- Cleveland Lou Ruvo Center for Brain Health at Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas J Grabowski
- Department of Radiology, University of Washington, Seattle, USA
- Department of Neurology, University of Washington, Seattle, USA
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Abstract
Human cerebrospinal fluid (CSF) contains diverse lipid particles, including lipoproteins that are distinct from their plasma counterparts and contain apolipoprotein (apo) E isoforms, apoJ, and apoAI, and extracellular vesicles, which can be detected by annexin V binding. The aim of this study was to develop a method to quantify CSF particles and evaluate their relationship to aging and neurodegenerative diseases. We used a flow cytometric assay to detect annexin V-, apoE-, apoAI-, apoJ-, and amyloid (A) β42-positive particles in CSF from 131 research volunteers who were neurologically normal or had mild cognitive impairment (MCI), Alzheimer disease (AD) dementia, or Parkinson disease. APOE ε4/ε4 participants had CSF apoE-positive particles that were more frequently larger but at an 88% lower level versus those in APOE ε3/ε3 or APOE ε3/ε4 patients; this finding was reproduced in conditioned medium from mouse primary glial cell cultures with targeted replacement of apoE. Cerebrospinal fluid apoE-positive and β-amyloid (Aβ42)-positive particle concentrations were persistently reduced one-third to one-half in middle and older age subjects; apoAI-positive particle concentration progressively increased approximately 2-fold with age. Both apoAI-positive and annexin V-positive CSF particle levels were reduced one-third to one-half in CSF of MCI and/or AD dementia patients versus age-matched controls. Our approach provides new methods to investigate CNS lipid biology in relation to neurodegeneration and perhaps develop new biomarkers for diagnosis or treatment monitoring.
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Mata IF, Leverenz JB, Weintraub D, Trojanowski JQ, Chen-Plotkin A, Van Deerlin VM, Ritz B, Rausch R, Factor SA, Wood-Siverio C, Quinn JF, Chung KA, Peterson-Hiller AL, Goldman JG, Stebbins GT, Bernard B, Espay AJ, Revilla FJ, Devoto J, Rosenthal LS, Dawson TM, Albert MS, Tsuang D, Huston H, Yearout D, Hu SC, Cholerton BA, Montine TJ, Edwards KL, Zabetian CP. GBA Variants are associated with a distinct pattern of cognitive deficits in Parkinson's disease. Mov Disord 2015; 31:95-102. [PMID: 26296077 DOI: 10.1002/mds.26359] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/18/2015] [Accepted: 07/06/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Loss-of-function mutations in the GBA gene are associated with more severe cognitive impairment in PD, but the nature of these deficits is not well understood and whether common GBA polymorphisms influence cognitive performance in PD is not yet known. METHODS We screened the GBA coding region for mutations and the E326K polymorphism in 1,369 PD patients enrolled at eight sites from the PD Cognitive Genetics Consortium. Participants underwent assessments of learning and memory (Hopkins Verbal Learning Test-Revised), working memory/executive function (Letter-Number Sequencing Test and Trail Making Test A and B), language processing (semantic and phonemic verbal fluency), visuospatial abilities (Benton Judgment of Line Orientation), and global cognitive function (MoCA). We used linear regression to test for association between genotype and cognitive performance with adjustment for important covariates and accounted for multiple testing using Bonferroni's corrections. RESULTS Mutation carriers (n = 60; 4.4%) and E326K carriers (n = 65; 4.7%) had a higher prevalence of dementia (mutations, odds ratio = 5.1; P = 9.7 × 10(-6) ; E326K, odds ratio = 6.4; P = 5.7 × 10(-7) ) and lower performance on Letter-Number Sequencing (mutations, corrected P[Pc ] = 9.0 × 10(-4) ; E326K, Pc = 0.036), Trail Making B-A (mutations, Pc = 0.018; E326K, Pc = 0.018), and Benton Judgment of Line Orientation (mutations, Pc = 0.0045; E326K, Pc = 0.0013). CONCLUSIONS Both GBA mutations and E326K are associated with a distinct cognitive profile characterized by greater impairment in working memory/executive function and visuospatial abilities in PD patients. The discovery that E326K negatively impacts cognitive performance approximately doubles the proportion of PD patients we now recognize are at risk for more severe GBA-related cognitive deficits.
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Affiliation(s)
- Ignacio F Mata
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Institute on Aging, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alice Chen-Plotkin
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Beate Ritz
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,Department of Environmental Health Sciences, School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - Rebecca Rausch
- Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - Stewart A Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Cathy Wood-Siverio
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joseph F Quinn
- Portland Veterans Affairs Medical Center, Portland, Oregon, USA.,Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Kathryn A Chung
- Portland Veterans Affairs Medical Center, Portland, Oregon, USA.,Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Amie L Peterson-Hiller
- Portland Veterans Affairs Medical Center, Portland, Oregon, USA.,Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Jennifer G Goldman
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Bryan Bernard
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Alberto J Espay
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Fredy J Revilla
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Johnna Devoto
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ted M Dawson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Solomon H. Snyder Department of Neuroscience and Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marilyn S Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Debby Tsuang
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Haley Huston
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Dora Yearout
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Shu-Ching Hu
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Brenna A Cholerton
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Thomas J Montine
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Karen L Edwards
- Department of Epidemiology, School of Medicine, University of California Irvine, Irvine, California, USA
| | - Cyrus P Zabetian
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
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Madhyastha TM, Askren MK, Zhang J, Leverenz JB, Montine TJ, Grabowski TJ. Group comparison of spatiotemporal dynamics of intrinsic networks in Parkinson's disease. Brain 2015; 138:2672-86. [PMID: 26173859 DOI: 10.1093/brain/awv189] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/07/2015] [Indexed: 12/21/2022] Open
Abstract
Recent advances with functional connectivity magnetic resonance imaging have demonstrated that at rest the brain exhibits coherent activity within a number of spatially independent maps, normally called 'intrinsic' or 'resting state' networks. These networks support cognition and behaviour, and are altered in neurodegenerative disease. However, there is a longstanding perspective, and ample functional magnetic resonance imaging evidence, demonstrating that intrinsic networks may be fractionated and that cortical elements may participate in multiple intrinsic networks at different times, dynamically changing alliances to adapt to cognitive demands. A method to probe the fine-grained spatiotemporal structure of networks may be more sensitive to subtle network changes that accompany heterogeneous cognitive deficits caused by a neurodegenerative disease such as Parkinson's disease. Here we tested the hypothesis that alterations to the latent (hidden) structure of intrinsic networks may reveal the impact of underlying pathophysiologic processes as assessed with cerebrospinal fluid biomarkers. Using a novel modelling approach that we call 'network kernel analysis', we compared fine-grained network ensembles (network kernels) that include overlapping cortical elements in 24 patients with Parkinson's disease (ages 45-86, 17 male) and normal cognition or mild cognitive impairment (n = 13), and 21 cognitively normal control subjects (ages 41-76, nine male). An omnibus measure of network disruption, calculated from correlations among network kernels, was correlated with cerebrospinal fluid biomarkers of pathophysiological processes in Parkinson's disease: concentrations of α-synuclein and amyloid-β42. Correlations among network kernels more accurately classified Parkinson's disease from controls than other functional neuroimaging measures. Inspection of the spatial maps related to the default mode network and a frontoparietal task control network kernel showed that the right insula, an area implicated in network shifting and associated with cognitive impairment in Parkinson's disease, was more highly correlated with both these networks in Parkinson's disease than in controls. In Parkinson's disease, increased correlation of the insula with the default mode network was related to lower attentional accuracy. We demonstrated that in an omnibus sense, correlations among network kernels describe biological impact of pathophysiological processes (through correlation with cerebrospinal fluid biomarkers) and clinical status (by classification of patient group). At a greater level of detail, we demonstrate aberrant involvement of the insula in the default mode network and the frontal frontoparietal task control network kernel. Network kernel analysis holds promise as a sensitive method for detecting biologically and clinical relevant changes to specific networks that support cognition and are impaired in Parkinson's disease.
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Affiliation(s)
- Tara M Madhyastha
- 1 Department of Radiology, University of Washington, Seattle, WA, USA
| | - Mary K Askren
- 1 Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jing Zhang
- 2 Department of Pathology, University of Washington, Seattle, WA, USA
| | - James B Leverenz
- 3 Lou Ruvo Centre for Brain Health, Neurological Institute, Cleveland Clinic, Las Vegas, NV, USA
| | - Thomas J Montine
- 2 Department of Pathology, University of Washington, Seattle, WA, USA
| | - Thomas J Grabowski
- 1 Department of Radiology, University of Washington, Seattle, WA, USA 4 Department of Neurology, University of Washington, Seattle, WA, USA
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Srivatsal S, Cholerton B, Leverenz JB, Wszolek ZK, Uitti RJ, Dickson DW, Weintraub D, Trojanowski JQ, Van Deerlin VM, Quinn JF, Chung KA, Peterson AL, Factor SA, Wood-Siverio C, Goldman JG, Stebbins GT, Bernard B, Ritz B, Rausch R, Espay AJ, Revilla FJ, Devoto J, Rosenthal LS, Dawson TM, Albert MS, Mata IF, Hu SC, Montine KS, Johnson C, Montine TJ, Edwards KL, Zhang J, Zabetian CP. Cognitive profile of LRRK2-related Parkinson's disease. Mov Disord 2015; 30:728-33. [PMID: 25650144 PMCID: PMC4397146 DOI: 10.1002/mds.26161] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/05/2014] [Accepted: 01/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that genetic factors play a role in the variability associated with cognitive performance in Parkinson's disease (PD). Mutations in the LRRK2 gene are the most common cause of monogenic PD; however, the cognitive profile of LRRK2-related PD is not well-characterized. METHODS A cohort of 1,447 PD patients enrolled in the PD Cognitive Genetics Consortium was screened for LRRK2 mutations and completed detailed cognitive testing. Associations between mutation carrier status and cognitive test scores were assessed using linear regression models. RESULTS LRRK2 mutation carriers (n = 29) demonstrated better performance on the Mini Mental State Examination (P = 0.03) and the Letter-Number Sequencing Test (P = 0.005). A smaller proportion of LRRK2 carriers were demented (P = 0.03). CONCLUSIONS Our cross-sectional study demonstrates better performance on certain cognitive tests, as well as lower rates of dementia in LRRK2-related PD. Future longitudinal studies are needed to determine whether LRRK2 mutation carriers exhibit slower cognitive decline. © 2015 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Brenna Cholerton
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - James B. Leverenz
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Ryan J. Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Institute on Aging, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vivianna M. Van Deerlin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph F. Quinn
- Portland Veterans Affairs Medical Center, Portland, Oregon, USA
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Kathryn A. Chung
- Portland Veterans Affairs Medical Center, Portland, Oregon, USA
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Amie L. Peterson
- Portland Veterans Affairs Medical Center, Portland, Oregon, USA
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Stewart A. Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Cathy Wood-Siverio
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer G. Goldman
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Glenn T. Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Bryan Bernard
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Beate Ritz
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, USA
- Department of Environmental Health Sciences, School of Public Health, University of California Los Angeles, Los Angeles, California, USA
- Department of Neurology, School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Rebecca Rausch
- Department of Neurology, School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Alberto J. Espay
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Fredy J. Revilla
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Johnna Devoto
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Liana S. Rosenthal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ted M. Dawson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marilyn S. Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ignacio F. Mata
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Shu-Ching Hu
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kathleen S. Montine
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Catherine Johnson
- Department of Epidemiology, School of Medicine, University of California Irvine, California, USA
| | - Thomas J. Montine
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Karen L. Edwards
- Department of Epidemiology, School of Medicine, University of California Irvine, California, USA
| | - Jing Zhang
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Cyrus P. Zabetian
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
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Association of cognitive domains with postural instability/gait disturbance in Parkinson's disease. Parkinsonism Relat Disord 2015; 21:692-7. [PMID: 25943529 DOI: 10.1016/j.parkreldis.2015.04.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/26/2015] [Accepted: 04/07/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Research suggests an association between global cognition and postural instability/gait disturbance (PIGD) in Parkinson disease (PD), but the relationship between specific cognitive domains and PIGD symptoms is not clear. This study examined the association of cognition (global and specific cognitive domains) with PIGD symptoms in a large, well-characterized sample of individuals with PD. METHODS Cognitive function was measured with a detailed neuropsychological assessment, including global cognition, executive function, memory, visuospatial function, and language. PIGD symptoms were measured using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III, Motor Examination subscale. Multiple linear regression analyses were performed to assess the relationship between cognition and PIGD symptoms with models adjusting for age, sex, education, enrollment site, disease duration, and motor symptom severity. RESULTS The analysis included 783 participants, with mean (standard deviation) age of 67.3 (9.7) years and median (interquartile range) MDS-UPDRS Motor Subscale score of 26 (17, 35). Deficits in global cognition, executive function, memory, and phonemic fluency were associated with more severe PIGD symptoms. Deficits in executive function were associated with impairments in gait, freezing, and postural stability, while visuospatial impairments were associated only with more severe freezing, and poorer memory function was associated only with greater postural instability. DISCUSSION While impairments in global cognition and aspects of executive functioning were associated with more severe PIGD symptoms, specific cognitive domains were differentially related to distinct PIGD components, suggesting the presence of multiple neural pathways contributing to associations between cognition and PIGD symptoms in persons with PD.
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Mata IF, Leverenz JB, Weintraub D, Trojanowski JQ, Hurtig HI, Van Deerlin VM, Ritz B, Rausch R, Rhodes SL, Factor SA, Wood-Siverio C, Quinn JF, Chung KA, Peterson AL, Espay AJ, Revilla FJ, Devoto J, Hu SC, Cholerton BA, Wan JY, Montine TJ, Edwards KL, Zabetian CP. APOE, MAPT, and SNCA genes and cognitive performance in Parkinson disease. JAMA Neurol 2015; 71:1405-12. [PMID: 25178429 DOI: 10.1001/jamaneurol.2014.1455] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Cognitive impairment is a common and disabling problem in Parkinson disease (PD) that is not well understood and is difficult to treat. Identification of genetic variants that influence the rate of cognitive decline or pattern of early cognitive deficits in PD might provide a clearer understanding of the etiopathogenesis of this important nonmotor feature. OBJECTIVE To determine whether common variation in the APOE, MAPT, and SNCA genes is associated with cognitive performance in patients with PD. DESIGN, SETTING, AND PARTICIPANTS We studied 1079 PD patients from 6 academic centers in the United States who underwent assessments of memory (Hopkins Verbal Learning Test-Revised [HVLT-R]), attention and executive function (Letter-Number Sequencing Test and Trail Making Test), language processing (semantic and phonemic verbal fluency tests), visuospatial skills (Benton Judgment of Line Orientation test), and global cognitive function (Montreal Cognitive Assessment). Participants underwent genotyping for the APOE ε2/ε3/ε4 alleles, MAPT H1/H2 haplotypes, and SNCA rs356219. We used linear regression to test for association between genotype and baseline cognitive performance with adjustment for age, sex, years of education, disease duration, and site. We used a Bonferroni correction to adjust for the 9 comparisons that were performed for each gene. MAIN OUTCOMES AND MEASURES Nine variables derived from 7 psychometric tests. RESULTS The APOE ε4 allele was associated with lower performance on the HVLT-R Total Recall (P = 6.7 × 10(-6); corrected P [Pc] = 6.0 × 10(-5)), Delayed Recall (P = .001; Pc = .009), and Recognition Discrimination Index (P = .004; Pc = .04); a semantic verbal fluency test (P = .002; Pc = .02); the Letter-Number Sequencing Test (P = 1 × 10(-5); Pc = 9 × 10(-5)); and Trail Making Test B minus Trail Making Test A (P = .002; Pc = .02). In a subset of 645 patients without dementia, the APOE ε4 allele was associated with lower scores on the HVLT-R Total Recall (P = .005; Pc = .045) and the semantic verbal fluency (P = .005; Pc = .045) measures. Variants of MAPT and SNCA were not associated with scores on any tests. CONCLUSIONS AND RELEVANCE Our data indicate that the APOE ε4 allele is an important predictor of cognitive function in PD across multiple domains. Among PD patients without dementia, the APOE ε4 allele was only associated with lower performance on word list learning and semantic verbal fluency, a pattern more typical of the cognitive deficits seen in early Alzheimer disease than PD.
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Affiliation(s)
- Ignacio F Mata
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington3Department of Neurology, University of Washington School of Medicine, Seattle
| | - James B Leverenz
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington2Parkinson's Disease Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington3Dep
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania, Philadelphia7Department of Psychiatry, University of Pennsylvania, Philadelphia8Parkinson's Disease Research, Education, and Clinical Center and Mental Illness Research, Education, and Clinical Center
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia10Institute on Aging, University of Pennsylvania, Philadelphia
| | - Howard I Hurtig
- Department of Neurology, University of Pennsylvania, Philadelphia
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
| | - Beate Ritz
- Department of Epidemiology, School of Public Health, University of California, Los Angeles12Department of Environmental Health Sciences, School of Public Health, University of California, Los Angeles13Department of Neurology, University of California, Los
| | - Rebecca Rausch
- Department of Neurology, University of California, Los Angeles
| | - Shannon L Rhodes
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Stewart A Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Cathy Wood-Siverio
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Joseph F Quinn
- Parkinson's Disease Research, Education, and Clinical Center,Portland Veterans Affairs Medical Center, Portland, Oregon16Department of Neurology, Oregon Health and Science University, Portland
| | - Kathryn A Chung
- Parkinson's Disease Research, Education, and Clinical Center,Portland Veterans Affairs Medical Center, Portland, Oregon16Department of Neurology, Oregon Health and Science University, Portland
| | - Amie L Peterson
- Parkinson's Disease Research, Education, and Clinical Center,Portland Veterans Affairs Medical Center, Portland, Oregon16Department of Neurology, Oregon Health and Science University, Portland
| | - Alberto J Espay
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Fredy J Revilla
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio18Department of Neurology, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio
| | - Johnna Devoto
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Shu-Ching Hu
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington2Parkinson's Disease Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington3Dep
| | - Brenna A Cholerton
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington4Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Jia Y Wan
- Department of Epidemiology, University of Washington, Seattle20currently with Department of Epidemiology, University of California, Irvine
| | - Thomas J Montine
- Department of Pathology, University of Washington School of Medicine, Seattle
| | - Karen L Edwards
- Department of Epidemiology, University of Washington, Seattle20currently with Department of Epidemiology, University of California, Irvine
| | - Cyrus P Zabetian
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington2Parkinson's Disease Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington3Dep
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Shi M, Liu C, Cook TJ, Bullock KM, Zhao Y, Ginghina C, Li Y, Aro P, Dator R, He C, Hipp MJ, Zabetian CP, Peskind ER, Hu SC, Quinn JF, Galasko DR, Banks WA, Zhang J. Plasma exosomal α-synuclein is likely CNS-derived and increased in Parkinson's disease. Acta Neuropathol 2014; 128:639-650. [PMID: 24997849 DOI: 10.1007/s00401-014-1314-y] [Citation(s) in RCA: 453] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/18/2014] [Accepted: 06/19/2014] [Indexed: 01/21/2023]
Abstract
Extracellular α-synuclein is important in the pathogenesis of Parkinson's disease (PD) and also as a potential biomarker when tested in the cerebrospinal fluid (CSF). The performance of blood plasma or serum α-synuclein as a biomarker has been found to be inconsistent and generally ineffective, largely due to the contribution of peripherally derived α-synuclein. In this study, we discovered, via an intracerebroventricular injection of radiolabeled α-synuclein into mouse brain, that CSF α-synuclein was readily transported to blood, with a small portion being contained in exosomes that are relatively specific to the central nervous system (CNS). Consequently, we developed a technique to evaluate the levels of α-synuclein in these exosomes in individual plasma samples. When applied to a large cohort of clinical samples (267 PD, 215 controls), we found that in contrast to CSF α-synuclein concentrations, which are consistently reported to be lower in PD patients compared to controls, the levels of plasma exosomal α-synuclein were substantially higher in PD patients, suggesting an increased efflux of the protein to the peripheral blood of these patients. Furthermore, although no association was observed between plasma exosomal and CSF α-synuclein, a significant correlation between plasma exosomal α-synuclein and disease severity (r = 0.176, p = 0.004) was observed, and the diagnostic sensitivity and specificity achieved by plasma exosomal α-synuclein were comparable to those determined by CSF α-synuclein. Further studies are clearly needed to elucidate the mechanism involved in the transport of CNS α-synuclein to the periphery, which may lead to a more convenient and robust assessment of PD clinically.
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Flow cytometry analysis of synaptosomes from post-mortem human brain reveals changes specific to Lewy body and Alzheimer's disease. J Transl Med 2014; 94:1161-72. [PMID: 25068655 PMCID: PMC4184945 DOI: 10.1038/labinvest.2014.103] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/10/2014] [Accepted: 06/13/2014] [Indexed: 01/25/2023] Open
Abstract
Synaptic dysfunction is thought to have an important role in the pathophysiology of neurodegenerative diseases, such as Alzheimer's disease (AD) and Lewy body disease (LBD). To improve our understanding of synaptic alterations in health and disease, we investigated synaptosomes prepared from post-mortem human cerebral cortex, putamen (PT), and two regions of the caudate nucleus, dorso-lateral (DL) and ventro-medial (VM), regions commonly affected in AD and LBD. We observed that the fraction of synaptosomal particles with reactivity for dopamine transporter (DAT) was significantly reduced in the PT and VM caudate of patients with neuropathological diagnosis of LBD. As expected, these differences also were reflected in direct measurements of dopamine (DA) and its metabolite, 3,4-dihydroxyphenylacetic acid (DOPAC), in caudate and PT of LBD patients. The fraction of synaptosomal particles positive for amyloid β (Aβ) was significantly increased in frontal cortical samples of patients with the neuropathological diagnosis of severe AD, and was positively correlated with disease progression. We also prepared synaptosomes from the striatum of mice with severe loss of DA neurons (Slc6a3-DTR mice) and wild-type littermate controls. We observed markedly reduced levels of DAT-positive synaptosomes in Slc6a3-DTR mice following exposure to diphtheria toxin (DT). Striatal levels of DA and DOPAC in Slc6a3-DTR mice also were reduced significantly following DT exposure. We conclude that flow cytometric analysis of synaptosomes prepared from human or mouse brain provides an opportunity to study expression of pathology-associated proteins and also the specific loss of dopaminergic nerve terminals. Hence, we believe it is a valid method to detect pathological changes at the level of the synapse in LBD as well as AD.
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Madhyastha TM, Askren MK, Boord P, Grabowski TJ. Dynamic connectivity at rest predicts attention task performance. Brain Connect 2014; 5:45-59. [PMID: 25014419 DOI: 10.1089/brain.2014.0248] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Consistent spatial patterns of coherent activity, representing large-scale networks, have been reliably identified in multiple populations. Most often, these studies have examined "stationary" connectivity. However, there is a growing recognition that there is a wealth of information in the time-varying dynamics of networks which has neural underpinnings, which changes with age and disease and that supports behavior. Using factor analysis of overlapping sliding windows across 25 participants with Parkinson disease (PD) and 21 controls (ages 41-86), we identify factors describing the covarying correlations of regions (dynamic connectivity) within attention networks and the default mode network, during two baseline resting-state and task runs. Cortical regions that support attention networks are affected early in PD, motivating the potential utility of dynamic connectivity as a sensitive way to characterize physiological disruption to these networks. We show that measures of dynamic connectivity are more reliable than comparable measures of stationary connectivity. Factors in the dorsal attention network (DAN) and fronto-parietal task control network, obtained at rest, are consistently related to the alerting and orienting reaction time effects in the subsequent Attention Network Task. In addition, the same relationship between the same DAN factor and the alerting effect was present during tasks. Although reliable, dynamic connectivity was not invariant, and changes between factor scores across sessions were related to changes in accuracy. In summary, patterns of time-varying correlations among nodes in an intrinsic network have a stability that has functional relevance.
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Affiliation(s)
- Tara M Madhyastha
- 1 Department of Radiology, University of Washington , Seattle, Washington
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Burdick DJ, Cholerton B, Watson GS, Siderowf A, Trojanowski JQ, Weintraub D, Ritz B, Rhodes SL, Rausch R, Factor SA, Wood-Siverio C, Quinn JF, Chung KA, Srivatsal S, Edwards KL, Montine TJ, Zabetian CP, Leverenz JB. People with Parkinson's disease and normal MMSE score have a broad range of cognitive performance. Mov Disord 2014; 29:1258-64. [PMID: 25073717 DOI: 10.1002/mds.25924] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 04/01/2014] [Accepted: 04/21/2014] [Indexed: 11/08/2022] Open
Abstract
Cognitive impairment, including dementia, is common in Parkinson's disease (PD). The Mini-Mental State Examination (MMSE) has been recommended as a screening tool for Parkinson's disease dementia (PDD), with values below 26 indicative of possible dementia. Using a detailed neuropsychological battery, we examined the range of cognitive impairment in PD patients with an MMSE score of 26 or higher. In this multicenter, cross-sectional, observational study, we performed neuropsychological testing in a sample of 788 PD patients with MMSE scores of 26 or higher. Evaluation included tests of global cognition, executive function, language, memory, and visuospatial skills. A consensus panel reviewed results for 342 subjects and assigned a diagnosis of no cognitive impairment, mild cognitive impairment, or dementia. Sixty-seven percent of the 788 subjects performed 1.5 standard deviations below the normative mean on at least one test. On eight of the 15 tests, more than 20% of subjects scored 1.5 standard deviations or more below the normative mean. Greatest impairments were found on Hopkins Verbal Learning and Digit Symbol Coding tests. The sensitivity of the MMSE to detect dementia was 45% in a subset of participants who underwent clinical diagnostic procedures. A remarkably wide range of cognitive impairment can be found in PD patients with a relatively high score on the MMSE, including a level of cognitive impairment consistent with dementia. Given these findings, clinicians must be aware of the limitations of the MMSE in detecting cognitive impairment, including dementia, in PD.
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Affiliation(s)
- Daniel J Burdick
- Booth Gardner Parkinson's Care Center, Evergreen Hospital Medical Center, Kirkland, WA
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Cholerton BA, Zabetian CP, Wan JY, Montine TJ, Quinn JF, Mata IF, Chung KA, Peterson A, Espay AJ, Revilla FJ, Devoto J, Watson GS, Hu SC, Leverenz JB, Edwards KL. Evaluation of mild cognitive impairment subtypes in Parkinson's disease. Mov Disord 2014; 29:756-64. [PMID: 24710804 DOI: 10.1002/mds.25875] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/26/2014] [Accepted: 03/03/2014] [Indexed: 01/10/2023] Open
Abstract
Mild cognitive impairment in Parkinson's disease (PD-MCI) is common and increases the risk for dementia. Establishing distinct PD-MCI cognitive subtypes could be valuable for eventually predicting those most likely to convert to dementia. However, the study of PD-MCI subtypes has not yielded consistent results among cohorts. To determine whether there are distinct cognitive subtypes among participants diagnosed with PD-MCI in the Pacific Northwest Udall Center Clinical Consortium, we cognitively subtyped 95 patients with PD-MCI, using the Movement Disorders Society Task Force diagnostic guidelines. Psychometric test scores were then subjected to principle components factor analysis to determine whether similar cognitive subgroups could be identified using statistical methodology. Multiple-domain PD-MCI was diagnosed in 95% of the sample, and a range of cognitive impairments were noted. Factor analysis yielded seven factors and demonstrated overlap of phonemic verbal fluency on two factors, as well as the loading of verbal fluency on the same factor as a visuospatial measure; however, these factors did not partition the sample into distinct cognitive subtypes. Separation of cognitive subtypes based on the current PD-MCI criteria, or via statistical methods, may not provide sufficient information to describe distinct PD groups. Future efforts to validate the PD-MCI criteria and identify combinations of genetic or other risk factors for cognitive impairment are warranted.
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Affiliation(s)
- Brenna A Cholerton
- Geriatric Research, Education, & Clinical Center, Seattle, Washington, USA; Department of Psychiatry & Behavioral Science, University of Washington School of Medicine, Seattle, Washington, USA
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