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Abstract
PURPOSE OF REVIEW GBA mutations are the most common known genetic cause of Parkinson's disease (PD). Its biological pathway may be important in idiopathic PD, since activity of the enzyme encoded by GBA, glucocerebrosidase, is reduced even among PD patients without GBA mutations. This article describes the structure and function of GBA, reviews recent literature on the clinical phenotype of GBA PD, and suggests future directions for research, counseling, and treatment. RECENT FINDINGS Several longitudinal studies have shown that GBA PD has faster motor and cognitive progression than idiopathic PD and that this effect is dose dependent. New evidence suggests that GBA mutations may be important in multiple system atrophy. Further, new interventional studies focusing on GBA PD are described. These studies may increase the interest of PD patients and caregivers in genetic counseling. GBA mutation status may help clinicians estimate PD progression, though mechanisms underlying GBA and synucleinopathy require further understanding.
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Parkinson's disease phenotype is influenced by the severity of the mutations in the GBA gene. Parkinsonism Relat Disord 2018; 55:45-49. [PMID: 29784561 DOI: 10.1016/j.parkreldis.2018.05.009] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/04/2018] [Accepted: 05/09/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Mutations in the glucocerebrosidase (GBA) gene are divided into mild and severe (mGBA, sGBA) based on their contribution to the phenotype of Gaucher disease (GD) among homozygotes. We conducted a longitudinal analysis of Parkinson's disease (PD) patients carrying mutations in the GBA gene to better characterize genotype-phenotype correlations. METHODS Patients underwent a comprehensive assessment of medical, neurological, cognitive and non-motor functions. Data from these patients was explored to evaluate differences in disease phenotype based on genotype. RESULTS A total of 355 PD patients participated in this study; 152 idiopathic PD patients, 139 mGBA, 48 sGBA and 16 GD-PD. Groups were similar in age, sex, years of education and age of onset. Both sGBA and GD-PD had higher Unified Parkinson Disease Rating Scale (UPDRS) scores (p = 0.041), higher frequencies of REM sleep behavior disorder (RBD) (p = 0.022) and hallucinations (p < 0.0001) compared to the other groups of patients. sGBA experienced more non-motor symptoms (p < 0.0001), depression (p < 0.001) and worse hyposmia (p = 0.010). Trail making test was significantly longer in GD-PD followed by sGBA, mGBA and iPD (p = 0.005). DISCUSSION Motor, cognitive, olfactory and psychiatric symptoms are more severe in sGBA and GD-PD compared to mGBA and iPD, reinforcing the notion that the severity of the PD phenotype is related to the severity of the mutation in the GBA gene.
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O'Regan G, deSouza RM, Balestrino R, Schapira AH. Glucocerebrosidase Mutations in Parkinson Disease. JOURNAL OF PARKINSONS DISEASE 2018; 7:411-422. [PMID: 28598856 DOI: 10.3233/jpd-171092] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Following the discovery of a higher than expected incidence of Parkinson Disease (PD) in Gaucher disease, a lysosomal storage disorder, mutations in the glucocerebrocidase (GBA) gene, which encodes a lysosomal enzyme involved in sphingolipid degradation were explored in the context of idiopathic PD. GBA mutations are now known to be the single largest risk factor for development of idiopathic PD. Clinically, on imaging and pharmacologically, GBA PD is almost identical to idiopathic PD, other than certain features that can be identified in the specialist research setting but not in routine clinical practice. In patients with a known GBA mutation, it is possible to monitor for prodromal signs of PD. The clinical similarity with idiopathic PD and the chance to identify PD at a pre-clinical stage provides a unique opportunity to research therapeutic options for early PD, before major irreversible neurodegeneration occurs. However, to date, the molecular mechanisms which lead to this increased PD risk in GBA mutation carriers are not fully elucidated. Experimental models to define the molecular mechanisms and test therapeutic options include cell culture, transgenic mice and other in vivo models amenable to genetic manipulation, such as drosophilia. Some key pathological pathways of interest in the context of GBA mutations include alpha synuclein aggregation, lysosomal-autophagy axis changes and endoplasmic reticulum stress. Therapeutic agents that exploit these pathways are being developed and include the small molecule chaperone Ambroxol. This review aims to summarise the main features of GBA-PD and provide insights into the pathological relevance of GBA mutations on molecular pathways and the therapeutic implications for PD resulting from investigation of the role of GBA in PD.
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Affiliation(s)
- Grace O'Regan
- Department of Clinical Neurosciences, UCL Institute of Neurology, Royal Free Campus, London, UK
| | - Ruth-Mary deSouza
- Department of Clinical Neurosciences, UCL Institute of Neurology, Royal Free Campus, London, UK
| | | | - Anthony H Schapira
- Department of Clinical Neurosciences, UCL Institute of Neurology, Royal Free Campus, London, UK
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Senkevich KA, Miliukhina IV, Beletskaia MV, Gracheva EV, Kudrevatykh AV, Nikolaev MA, Emelyanov AK, Kopytova AE, Timofeeva AA, Yakimovskii AF, Pchelina SN. [The clinical features of Parkinson's disease in patients with mutations and polymorphic variants of GBA gene]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 117:81-86. [PMID: 29171494 DOI: 10.17116/jnevro201711710181-86] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mutations in the glucocerebrosidase gene (GBA) increase the risk of Parkinson's disease (PD) by 6-10 times in all populations and are associated with the early-onset of PD, development of cognitive impairment and presence of psychotic disorders. At the same time, polymorphic variants associated with the twofold increase in the risk of PD were also described in the GBA gene. AIM To estimate the clinical features of PD in patients with mutations and polymorphic variants of the GBA gene. MATERIAL AND METHODS Evaluation of motor, cognitive, emotional, psychotic and autonomic dysfunctions in patients with mutations (N370S, L444P) and polymorphic variants (E326K, T369M) in the GBA gene was performed using clinical scales. RESULTS Patients with mutations (mGBA-PD), and with polymorphic variants (pGBA-PD) in the GBA gene were compared with the group of patients with sporadic PD (sPD). Compared to sPD, affective disorders (depression and anxiety) were more expressed in the mGBA-PD group (p=0.001) and the general GBA-PD group (p=0.001) assessed with Sheehan anxiety rating scale, in the pGBA-PD group (p=0.012) and the general GBA-PD group (p=0.05) assessed with the NPI, in the mGBA-PD (p=0.003), pGBA-PD (p=0.022), and general GBA-PD groups (p=0.001) assessed with the Hospital Anxiety and Depression scale (HADS 'A'), and in the pGBA-PD group (p=0.005) assessed with the HADS 'D'. Non-motor symptoms assessed with the PD-NMS were more expressed in the pGBA-PD patients (p=0.007) and in the total group with GBA-PD (p=0,014) compared to sPD. Cognitive impairment measured with MMSE was more marked in mGBA-PD patients (p=0.022). Differences in motor and non-motor clinical symptoms between pGBA-PD and mGBA-PD groups were not found. CONCLUSION Thus, clinical features of non-motor symptoms were described both in carriers of GBA mutations and polymorphisms. Identification of the specific clinical phenotype of PD in carriers of GBA polymorphic variants is important due to their relatively high prevalence in PD patients.
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Affiliation(s)
- K A Senkevich
- Institute of Experimental Medicine, St. Petersburg, Russia; Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia; National Research Center 'Kurchatov Institute' Konstantinov Petersburg Nuclear Physics Institute, St. Petersburg, Russia
| | - I V Miliukhina
- Institute of Experimental Medicine, St. Petersburg, Russia; Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - M V Beletskaia
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - E V Gracheva
- Institute of Experimental Medicine, St. Petersburg, Russia
| | | | - M A Nikolaev
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia; National Research Center 'Kurchatov Institute' Konstantinov Petersburg Nuclear Physics Institute, St. Petersburg, Russia
| | - A K Emelyanov
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia; National Research Center 'Kurchatov Institute' Konstantinov Petersburg Nuclear Physics Institute, St. Petersburg, Russia
| | - A E Kopytova
- National Research Center 'Kurchatov Institute' Konstantinov Petersburg Nuclear Physics Institute, St. Petersburg, Russia
| | - A A Timofeeva
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - A F Yakimovskii
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - S N Pchelina
- Institute of Experimental Medicine, St. Petersburg, Russia; Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia; National Research Center 'Kurchatov Institute' Konstantinov Petersburg Nuclear Physics Institute, St. Petersburg, Russia
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Jin H, Chen J, Li K, Zhang JR, Gu CC, Mao CJ, Yang YP, Wang F, Liu CF. A novel p.L216I mutation in the glucocerebrosidase gene is associated with Parkinson's disease in Han Chinese patients. Neurosci Lett 2018. [PMID: 29530815 DOI: 10.1016/j.neulet.2018.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Pathogenic mutations in the glucocerebrosidase (GBA) gene are associated with Parkinson's disease (PD), of which L444P and N370S are the most frequently observed in patients with PD. The aim of this study was to systematically explore variations in the coding regions of GBA in Han Chinese patients with PD, as well as to expand the GBA mutation spectrum. MATERIAL AND METHODS A total of 213 Han Chinese patients with PD and 348 controls were enrolled in the study. Whole coding regions of GBA were captured and sequenced by target region sequencing. Sanger sequencing was also used to confirm the identified variants. RESULTS We identified a novel variant (c. C646A; p.L216I; NM_001171811.1) of GBA in two unrelated patients, which was not observed in the controls. Both patients had early-onset PD and neither exhibited any motor-related symptoms. However, we did not find an L444P or N370S mutations in our patients. CONCLUSIONS The p.L216I mutation is a novel GBA mutation, which we identified in two Han Chinese patients with PD. The patients exhibited similar characteristics, which differed from those seen in patients with other GBA mutations. Future work is needed to investigate this mutation further, as well as larger cohort studies to explore other GBA mutations associated with PD in the Han Chinese and in other populations.
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Affiliation(s)
- Hong Jin
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jing Chen
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Kai Li
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jin-Ru Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chen-Chen Gu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Cheng-Jie Mao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ya-Ping Yang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China; Institute of Neuroscience, Soochow University, Suzhou 215123, China
| | - Feng Wang
- Institute of Neuroscience, Soochow University, Suzhou 215123, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China; Institute of Neuroscience, Soochow University, Suzhou 215123, China; Jiangsu Key Laboratory of Translational Research and Therapy for Neuro-Psycho-Diseases, Soochow University, Suzhou, China; Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing, China.
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Jellinger KA, Korczyn AD. Are dementia with Lewy bodies and Parkinson's disease dementia the same disease? BMC Med 2018; 16:34. [PMID: 29510692 PMCID: PMC5840831 DOI: 10.1186/s12916-018-1016-8] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/30/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), which share many clinical, neurochemical, and morphological features, have been incorporated into DSM-5 as two separate entities of major neurocognitive disorders with Lewy bodies. Despite clinical overlap, their diagnosis is based on an arbitrary distinction concerning the time of onset of motor and cognitive symptoms, namely as early cognitive impairment in DLB and later onset following that of motor symptoms in PDD. Their morphological hallmarks - cortical and subcortical α-synuclein/Lewy body plus β-amyloid and tau pathologies - are similar, but clinical differences at onset suggest some dissimilar profiles. Based on recent publications, including the fourth consensus report of the DLB Consortium, a critical overview is provided herein. DISCUSSION The clinical constellations of DLB and PDD include cognitive impairment, parkinsonism, visual hallucinations, and fluctuating attention. Intravitam PET and postmortem studies have revealed a more pronounced cortical atrophy, elevated cortical and limbic Lewy body pathologies, higher Aβ and tau loads in cortex and striatum in DLB compared to PDD, and earlier cognitive defects in DLB. Conversely, multitracer PET studies have shown no differences in cortical and striatal cholinergic and dopaminergic deficits. Clinical management of both DLB and PDD includes cholinesterase inhibitors and other pharmacologic and non-drug strategies, yet with only mild symptomatic effects. Currently, no disease-modifying therapies are available. CONCLUSION DLB and PDD are important dementia syndromes that overlap in many clinical features, genetics, neuropathology, and management. They are currently considered as subtypes of an α-synuclein-associated disease spectrum (Lewy body diseases), from incidental Lewy body disease and non-demented Parkinson's disease to PDD, DLB, and DLB with Alzheimer's disease at the most severe end. Cognitive impairment in these disorders is induced not only by α-synuclein-related neurodegeneration but by multiple regional pathological scores. Both DLB and PDD show heterogeneous pathology and neurochemistry, suggesting that they share important common underlying molecular pathogenesis with Alzheimer's disease and other proteinopathies. While we prefer to view DLB and PDD as extremes on a continuum, there remains a pressing need to more clearly differentiate these syndromes and to understand the synucleinopathy processes leading to either one.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150, Vienna, Austria.
| | - Amos D Korczyn
- Tel-Aviv University, Sackler Faculty of Medicine, Ramat Aviv, Israel
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Creese B, Bell E, Johar I, Francis P, Ballard C, Aarsland D. Glucocerebrosidase mutations and neuropsychiatric phenotypes in Parkinson's disease and Lewy body dementias: Review and meta-analyses. Am J Med Genet B Neuropsychiatr Genet 2018; 177:232-241. [PMID: 28548708 DOI: 10.1002/ajmg.b.32549] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/07/2017] [Accepted: 04/20/2017] [Indexed: 12/26/2022]
Abstract
Heterozygous mutations in glucocerebrosidase gene (GBA) are a major genetic risk factor for Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Recently, there has been a considerable focus on the relationship between GBA mutations and emergence of cognitive impairment and neuropsychiatric symptoms in these diseases. Here, we review the literature in this area, with a particular focus, including meta-analysis, on the key neuropsychiatric symptoms of cognitive impairment, psychosis, and depression in Parkinson's disease. Our meta-analysis demonstrated that GBA mutations are associated with a 2.4-fold increased risk of cognitive impairment. In addition, our novel meta-analyses of psychosis and depression showed a 1.8- and 2.2-fold increased risk respectively associated with GBA mutations, although due to possible bias and heterogeneity the depression findings should be interpreted with caution. While the precise mechanisms which increase susceptibility to neurodegeneration in GBA carriers are not known, evidence of greater cortical Lewy body pathology, reduced patterns of cortical activation, and hippocampal pathology in animal models are all consistent with a direct effect of GBA mutations on these symptoms. Extension of this work in DLB and individuals without neurodegeneration will be important in further characterizing how GBA mutations increase risk for PD and DLB and influence disease course.
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Affiliation(s)
- Byron Creese
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Emily Bell
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iskandar Johar
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Francis
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Clive Ballard
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Marshall MS, Jakubauskas B, Bogue W, Stoskute M, Hauck Z, Rue E, Nichols M, DiAntonio LL, van Breemen RB, Kordower JH, Saavedra-Matiz CA, Bongarzone ER. Analysis of age-related changes in psychosine metabolism in the human brain. PLoS One 2018; 13:e0193438. [PMID: 29481565 PMCID: PMC5826537 DOI: 10.1371/journal.pone.0193438] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/09/2018] [Indexed: 12/15/2022] Open
Abstract
α-Synuclein aggregation has been linked to Gaucher’s disease (GD) and Krabbe’s disease (KD), lysosomal conditions affecting glycosphingolipid metabolism. α-Synuclein pathology has been directly attributed to the dysregulation of glycosphingolipids in both conditions, specifically to increased galactosylsphingosine (psychosine) content in the context of KD. Furthermore, the gene (GALC) coding for the psychosine degrading enzyme galactosylceramidase (GALC), has recently been identified as a risk loci for Parkinson’s disease. However, it is unknown if changes in psychosine metabolism and GALC activity in the context of the aging human brain correlate with Parkinson’s disease. We investigated psychosine accumulation and GALC activity in the aging brain using fresh frozen post-mortem tissue from Parkinson’s (PD, n = 10), Alzheimer’s (AD, n = 10), and healthy control patients (n = 9), along with tissue from neuropsychiatric patients (schizophrenia, bipolar disorder and depression, n = 15 each). An expanded mutational analysis of PD (n = 20), AD (n = 10), and healthy controls (n = 30) examined if PD was correlated with carriers for severe GALC mutations. Psychosine content within the cerebral cortex of PD patients was elevated above control patients. Within all patients, psychosine displayed a significant (p<0.05) and robust regional distribution in the brain with higher levels in the white matter and substantia nigra. A mutational analysis revealed an increase in the incidence of severe GALC mutations within the PD patient population compared to the cohorts of Alzheimer’s patients and healthy controls tested. In addition to α-synuclein pathology identified in the KD brain, control patients identified as GALC mutational carriers or possessing a GALC pathogenic variant had evidence of α-synuclein pathology, indicating a possible correlation between α-synuclein pathology and dysregulation of psychosine metabolism in the adult brain. Carrier status for GALC mutations and prolonged exposure to increased psychosine could contribute to α-synuclein pathology, supporting psychosine metabolism by galactosylceramidase as a risk factor for Parkinson’s disease.
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Affiliation(s)
- Michael S. Marshall
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Benas Jakubauskas
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Wil Bogue
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Monika Stoskute
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Zane Hauck
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Emily Rue
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Matthew Nichols
- Division of Genetics, Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, United States of America
| | - Lisa L. DiAntonio
- Division of Genetics, Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, United States of America
| | - Richard B. van Breemen
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Jeffrey H. Kordower
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States of America
| | - Carlos A. Saavedra-Matiz
- Division of Genetics, Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, United States of America
| | - Ernesto R. Bongarzone
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
- Departamento de Química Biologica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
- * E-mail:
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110
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Gegg ME, Schapira AHV. The role of glucocerebrosidase in Parkinson disease pathogenesis. FEBS J 2018; 285:3591-3603. [DOI: 10.1111/febs.14393] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/17/2018] [Accepted: 01/25/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Matthew E. Gegg
- Department of Clinical Neuroscience; Institute of Neurology; University College London; UK
| | - Anthony H. V. Schapira
- Department of Clinical Neuroscience; Institute of Neurology; University College London; UK
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Koros C, Stamelou M, Simitsi A, Beratis I, Papadimitriou D, Papagiannakis N, Fragkiadaki S, Kontaxopoulou D, Papageorgiou SG, Stefanis L. Selective cognitive impairment and hyposmia in p.A53T SNCA PD vs typical PD. Neurology 2018; 90:e864-e869. [DOI: 10.1212/wnl.0000000000005063] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 12/04/2017] [Indexed: 02/07/2023] Open
Abstract
ObjectiveTo evaluate nonmotor symptoms in early SNCA/p.A53T Parkinson disease (PD) (A53T PD) compared to typical PD (tPD).MethodsThe presence of hyposmia, neuropsychiatric, dysautonomic, and sleep disturbances was assessed by standardized questionnaires and validated scales in 18 patients with A53T PD and 18 patients with tPD, matched for age, sex, and disease duration. All patients were enrolled into the Parkinson's Progression Markers Initiative study.ResultsThe levodopa equivalent daily dose was higher in the A53T PD (p = 0.018) group vs the tPD group. Scores on the University of Pennsylvania Smell Identification Test (p = 0.001), Benton Judgement of Line Orientation test (p = 0.001), Letter Number Sequencing Test (p = 0.002), and phonemic verbal fluency (p = 0.002) were lower in the A53T PD group vs the tPD group. In contrast, overall cognition, verbal memory, and semantic fluency were similar between groups.ConclusionThe observed selective cognitive impairment reflecting frontal-parietal network dysfunction, together with impaired olfaction, define a set of nonmotor dysfunctions related to A53T PD. These results have implications for the prognosis of patients with A53T PD. Moreover, as the archetypal α-synucleinopathy, such results may give insights into tPD.
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112
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Balestrino R, Schapira AHV. Glucocerebrosidase and Parkinson Disease: Molecular, Clinical, and Therapeutic Implications. Neuroscientist 2018; 24:540-559. [PMID: 29400127 DOI: 10.1177/1073858417748875] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parkinson disease (PD) is a complex neurodegenerative disease characterised by multiple motor and non-motor symptoms. In the last 20 years, more than 20 genes have been identified as causes of parkinsonism. Following the observation of higher risk of PD in patients affected by Gaucher disease, a lysosomal disorder caused by mutations in the glucocerebrosidase (GBA) gene, it was discovered that mutations in this gene constitute the single largest risk factor for development of idiopathic PD. Patients with PD and GBA mutations are clinically indistinguishable from patients with idiopathic PD, although some characteristics emerge depending on the specific mutation, such as slightly earlier onset. The molecular mechanisms which lead to this increased PD risk in GBA mutation carriers are multiple and not yet fully elucidated, they include alpha-synuclein aggregation, lysosomal-autophagy dysfunction and endoplasmic reticulum stress. Moreover, dysfunction of glucocerebrosidase has also been demonstrated in non-GBA PD, suggesting its interaction with other pathogenic mechanisms. Therefore, GBA enzyme function represents an interesting pharmacological target for PD. Cell and animal models suggest that increasing GBA enzyme activity can reduce alpha-synuclein levels. Clinical trials of ambroxol, a glucocerebrosidase chaperone, are currently ongoing in PD and PD dementia, as is a trial of substrate reduction therapy. The aim of this review is to summarise the main features of GBA-PD and discuss the implications of glucocerebrosidase modulation on PD pathogenesis.
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Affiliation(s)
| | - Anthony H V Schapira
- 2 Department of Clinical Neurosciences, UCL Institute of Neurology, Royal Free Campus, London, UK
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113
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Gan-Or Z, Alcalay RN, Rouleau GA, Postuma RB. Sleep disorders and Parkinson disease; lessons from genetics. Sleep Med Rev 2018; 41:101-112. [PMID: 29449121 DOI: 10.1016/j.smrv.2018.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/04/2017] [Accepted: 01/15/2018] [Indexed: 02/08/2023]
Abstract
Parkinson disease is a common, age-related neurodegenerative disorder, projected to afflict millions of individuals in the near future. Understanding its etiology and identifying clinical, genetic or biological markers for Parkinson disease onset and progression is therefore of major importance. Various sleep-related disorders are the most common group of non-motor symptoms in advanced Parkinson disease, but they can also occur during its prodromal phase. However, with the exception of REM sleep behavior disorder, it is unclear whether they are part of the early pathological process of Parkinson disease, or if they develop as Parkinson disease advances because of treatments and neurodegeneration progression. The advancements in genetic studies in the past two decades have generated a wealth of information, and recent genetic studies offer new insight on the association of sleep-related disorders with Parkinson disease. More specifically, comparing genetic data between Parkinson disease and sleep-related disorders can clarify their association, which may assist in determining whether they can serve as clinical markers for Parkinson disease risk or progression. In this review, we discuss the current knowledge on the genetics of sleep-related disorders in Parkinson disease context, and the potential implications on research, diagnosis, counseling and treatment.
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Affiliation(s)
- Ziv Gan-Or
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada; Department of Human Genetics, McGill University, Montréal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.
| | - Roy N Alcalay
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Guy A Rouleau
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada; Department of Human Genetics, McGill University, Montréal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Ronald B Postuma
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
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Cortical thinning correlates of changes in visuospatial and visuoperceptual performance in Parkinson's disease: A 4-year follow-up. Parkinsonism Relat Disord 2018; 46:62-68. [DOI: 10.1016/j.parkreldis.2017.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/26/2017] [Accepted: 11/06/2017] [Indexed: 12/16/2022]
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Lythe V, Athauda D, Foley J, Mencacci NE, Jahanshahi M, Cipolotti L, Hyam J, Zrinzo L, Hariz M, Hardy J, Limousin P, Foltynie T. GBA-Associated Parkinson’s Disease: Progression in a Deep Brain Stimulation Cohort. JOURNAL OF PARKINSONS DISEASE 2017; 7:635-644. [DOI: 10.3233/jpd-171172] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Vanessa Lythe
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Dilan Athauda
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Jennifer Foley
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Niccolò E. Mencacci
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marjan Jahanshahi
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jonathan Hyam
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Marwan Hariz
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - John Hardy
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | - Tom Foltynie
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
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Moran EE, Wang C, Katz M, Ozelius L, Schwartz A, Pavlovic J, Ortega RA, Lipton RB, Zimmerman ME, Saunders-Pullman R. Cognitive and motor functioning in elderly glucocerebrosidase mutation carriers. Neurobiol Aging 2017; 58:239.e1-239.e7. [PMID: 28728889 PMCID: PMC5647652 DOI: 10.1016/j.neurobiolaging.2017.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/13/2017] [Accepted: 06/18/2017] [Indexed: 01/27/2023]
Abstract
Mutations in the glucocerebrosidase (GBA) gene are a strong genetic risk factor for the development of Parkinson's disease and dementia with Lewy Bodies. However the penetrance of GBA mutations is low for these diseases in heterozygous carriers. The aim of this study was to examine the relationship between mutation status and cognitive and motor functioning in a sample of community-dwelling older adults. Using linear mixed effects models, we examined the effect of heterozygous mutation status on 736 community-dwelling older adults (≥70 years) without dementia or Parkinson's disease assessed over an average of 6 years, 28 of whom had a single GBA mutation (primarily N370S). Verbal memory was measured using the picture version of the Free and Cued Selective Reminding Test, and carriers showed significantly (p < 0.05) greater decline in verbal memory over time. There was no difference in motor function or any other cognitive domain. Taken together, these results suggest an effect, but an overall limited burden, of harboring a single GBA mutation in aging mutation carriers.
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Affiliation(s)
- Eileen E Moran
- Department of Psychology, Fordham University, Bronx, NY, USA.
| | - Cuiling Wang
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mindy Katz
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Laurie Ozelius
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alison Schwartz
- Department of Neurology, Mount Sinai Beth Israel, New York, NY, USA
| | - Jelena Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Roberto A Ortega
- Department of Neurology, Mount Sinai Beth Israel, New York, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Molly E Zimmerman
- Department of Psychology, Fordham University, Bronx, NY, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rachel Saunders-Pullman
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurology, Mount Sinai Beth Israel, New York, NY, USA
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Sato S, Li Y, Hattori N. Lysosomal defects in ATP13A2 and GBA associated familial Parkinson's disease. J Neural Transm (Vienna) 2017; 124:1395-1400. [PMID: 28894968 DOI: 10.1007/s00702-017-1779-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/11/2017] [Indexed: 01/02/2023]
Abstract
Genes encoding lysosomal proteins, such as ATP13A2 and GBA, are associated with familial Parkinson's disease (PD). Heterozygous mutations in GBA are strongly associated with familial PD. ATP13A2, which encodes a lysosomal P-type ATPase, has been identified as the causative gene for Kufor-Rakeb syndrome. While lysosomal dysfunction due to these mutations exhibited early onset Parkinsonism, each animal model demonstrated different pathological mechanisms. Clinicogenetic and animal model studies recently identified several lysosomal alterations that play a role in the pathogenesis of PD.
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Affiliation(s)
- Shigeto Sato
- Department of Neurology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuanzhe Li
- Research Institute for Diseases of Old Age, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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118
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Peall KJ, Lorentzos MS, Heyman I, Tijssen MAJ, Owen MJ, Dale RC, Kurian MA. A review of psychiatric co-morbidity described in genetic and immune mediated movement disorders. Neurosci Biobehav Rev 2017; 80:23-35. [PMID: 28528196 DOI: 10.1016/j.neubiorev.2017.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 12/19/2022]
Abstract
Psychiatric symptoms are an increasingly recognised feature of movement disorders. Recent identification of causative genes and autoantibodies has allowed detailed analysis of aetiologically homogenous subgroups, thereby enabling determination of the spectrum of psychiatric symptoms in these disorders. This review evaluates the incidence and type of psychiatric symptoms encountered in patients with movement disorders. A broad spectrum of psychiatric symptoms was identified across all subtypes of movement disorder, with depression, generalised anxiety disorder and obsessive-compulsive disorder being most common. Psychosis, schizophrenia and attention deficit hyperactivity disorder were also identified, with the psychiatric symptoms often predating onset of the motor disorder. The high incidence of psychiatric symptoms across such a wide range of movement disorders suggests a degree of common or overlapping pathogenic mechanisms. Our review demonstrates the need for increased clinical awareness of such co-morbidities, which should facilitate early neuropsychiatric intervention and allied specialist treatment for patients.
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Affiliation(s)
- K J Peall
- MRC Centre for Neuropsychiatric Genetics and Genomics, Hadyn Ellis Building, Heath Park, Cardiff, CF24 4HQ, UK.
| | - M S Lorentzos
- Movement Disorders Clinic, The Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia
| | - I Heyman
- Department of Psychological Medicine, Great Ormond Street Hospital, London, UK; Developmental Neurosciences Programme, UCL-Institute of Child Health, London, UK
| | - M A J Tijssen
- Department of Neurology, University of Groningen, Groningen, The Netherlands
| | - M J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Hadyn Ellis Building, Heath Park, Cardiff, CF24 4HQ, UK
| | - R C Dale
- Movement Disorders Clinic, The Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia
| | - M A Kurian
- Developmental Neurosciences Programme, UCL-Institute of Child Health, London, UK; Department of Neurology, Great Ormond Street Hospital, London, UK.
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Gustavsson EK, Trinh J, McKenzie M, Bortnick S, Petersen MS, Farrer MJ, Aasly JO. Genetic Identification in Early Onset Parkinsonism among Norwegian Patients. Mov Disord Clin Pract 2017; 4:499-508. [PMID: 30363439 PMCID: PMC6174458 DOI: 10.1002/mdc3.12501] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/26/2017] [Accepted: 04/05/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND An initial diagnosis of Parkinson's disease (PD) is challenging, especially in patients who have early onset and atypical disease. A genetic etiology for parkinsonism, when established, ends that diagnostic odyssey and may inform prognosis and therapy. The objective of this study was to elucidate the genetic etiology of parkinsonism in patients with early onset disease (age at onset <45 years). METHODS Whole-exome sequencing, copy number variability, and short tandem repeat analyses were performed. The analyses were focused on genes previously implicated in parkinsonism and dystonia in patients with early onset parkinsonism. Genotype-phenotype correlations were assessed using regression models. RESULTS The patient cohort was characterized by early onset, slowly progressive parkinsonism with a mean age at onset of 39.2 ± 5.0 years (n = 108). By 10 years of disease duration, the mean Hoehn & Yahr stage was 2.6 ± 0.8, the mean Unified Parkinson's Disease Rating Scale, part III (motor part) score was 24.9 ± 12.1 (n = 83), and 30 patients were cognitively impaired at the last examination (Montreal Cognitive Assessment score ≤ 26). Ten patients with typical early onset PD harbored homozygous or compound heterozygous mutations phosphatase and tensin homolog-induced putative kinase 1 (PINK1) (n = 4), parkin (PRKN) (n = 3), or the leucine-rich repeat kinase 2 (LRRK2) c.6055 G to A transition (n = 3). In addition, 5 patients with more atypical disease were compound heterozygotes for the glucocerebrosidase gene (GBA) (n = 3) 1 was heterozygous for solute carrier family 2, member 1 (SLC2A1) and another carried a novel ataxin 2 (ATXN2) exon 1 duplication. In most patients, the cumulative mutational burden did not appear to contribute to age at onset or progression. CONCLUSION In this clinical series, 15 patients (14%) carried mutations that were linked to monogenic parkinsonism. GBA carriers were most likely to suffer an earlier cognitive demise. Nevertheless, the etiology for most patients with early onset PD remains to be determined.
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Affiliation(s)
- Emil K. Gustavsson
- Center for Applied NeurogeneticsDjavad Mowafaghian Center for Brain HealthDepartment of Medical GeneticsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of NeuroscienceNorwegian University of Science and TechnologyTrondheimNorway
- Department of NeurologySt. Olav's HospitalTrondheimNorway
| | - Joanne Trinh
- Center for Applied NeurogeneticsDjavad Mowafaghian Center for Brain HealthDepartment of Medical GeneticsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Marna McKenzie
- Center for Applied NeurogeneticsDjavad Mowafaghian Center for Brain HealthDepartment of Medical GeneticsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Stephanie Bortnick
- Center for Applied NeurogeneticsDjavad Mowafaghian Center for Brain HealthDepartment of Medical GeneticsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Maria Skaalum Petersen
- Department of Occupational Medicine and Public HealthThe Faroese Hospital SystemTorshavnFaroe Islands
| | - Matthew J. Farrer
- Center for Applied NeurogeneticsDjavad Mowafaghian Center for Brain HealthDepartment of Medical GeneticsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Jan O. Aasly
- Department of NeuroscienceNorwegian University of Science and TechnologyTrondheimNorway
- Department of NeurologySt. Olav's HospitalTrondheimNorway
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Abstract
Cognitive decline is now recognized as a common nonmotor symptom of Parkinson's disease, and it has been the subject of increasing research in recent decades. Cognitive deficits in Parkinson's disease can be distinguished as dopaminergically mediated executive dysfunction seen in the milder stages vs a global dementia syndrome that can occur with disease progression. The neural basis of these deficits has been explored from the perspective of multimodal imaging techniques to measure the structural, functional, and metabolic correlates of cognitive decline in Parkinson's disease. Increasingly, changes in neurotransmitter systems beyond dopamine, including the noradrenergic, serotonergic, and cholinergic systems, are being recognized for their contribution to cognitive decline. The impact of certain genetic variations on cognitive function has also been established, including links between cognitive decline and polymorphisms affecting COMT, MAPT, APOE, and GBA genotypes. Although therapeutic options for cognitive decline are still far less established than for motor systems, both pharmacological and nonpharmacological strategies are continuing to develop.
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121
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Mata IF, Johnson CO, Leverenz JB, Weintraub D, Trojanowski JQ, Van Deerlin VM, Ritz B, Rausch R, Factor SA, Wood-Siverio C, Quinn JF, Chung KA, Peterson-Hiller AL, Espay AJ, Revilla FJ, Devoto J, Yearout D, Hu SC, Cholerton BA, Montine TJ, Edwards KL, Zabetian CP. Large-scale exploratory genetic analysis of cognitive impairment in Parkinson's disease. Neurobiol Aging 2017; 56:211.e1-211.e7. [PMID: 28526295 DOI: 10.1016/j.neurobiolaging.2017.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/19/2017] [Accepted: 04/12/2017] [Indexed: 11/25/2022]
Abstract
Cognitive impairment is a common and disabling problem in Parkinson's disease (PD). Identification of genetic variants that influence the presence or severity of cognitive deficits in PD might provide a clearer understanding of the pathophysiology underlying this important nonmotor feature. We genotyped 1105 PD patients from the PD Cognitive Genetics Consortium for 249,336 variants using the NeuroX array. Participants underwent assessments of learning and memory (Hopkins Verbal Learning Test-Revised [HVLT-R]), working memory/executive function (Letter-Number Sequencing and Trail Making Test [TMT] A and B), language processing (semantic and phonemic verbal fluency), visuospatial abilities (Benton Judgment of Line Orientation [JoLO]), and global cognitive function (Montreal Cognitive Assessment). For common variants, we used linear regression to test for association between genotype and cognitive performance with adjustment for important covariates. Rare variants were analyzed using the optimal unified sequence kernel association test. The significance threshold was defined as a false discovery rate-corrected p-value (PFDR) of 0.05. Eighteen common variants in 13 genomic regions exceeded the significance threshold for one of the cognitive tests. These included GBA rs2230288 (E326K; PFDR = 2.7 × 10-4) for JoLO, PARP4 rs9318600 (PFDR = 0.006), and rs9581094 (PFDR = 0.006) for HVLT-R total recall, and MTCL1 rs34877994 (PFDR = 0.01) for TMT B-A. Analysis of rare variants did not yield any significant gene regions. We have conducted the first large-scale PD cognitive genetics analysis and nominated several new putative susceptibility genes for cognitive impairment in PD. These results will require replication in independent PD cohorts.
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Affiliation(s)
- Ignacio F Mata
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Catherine O Johnson
- Department of Epidemiology, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Weintraub
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - John Q Trojanowski
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA; Institute on Aging, University of Pennsylvania, Philadelphia, PA, USA
| | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Beate Ritz
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA; Department of Environmental Health Sciences, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Rebecca Rausch
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Stewart A Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Cathy Wood-Siverio
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph F Quinn
- Portland Veterans Affairs Medical Center, Portland, OR, USA; Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Kathryn A Chung
- Portland Veterans Affairs Medical Center, Portland, OR, USA; Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Amie L Peterson-Hiller
- Portland Veterans Affairs Medical Center, Portland, OR, USA; Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Alberto J Espay
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Fredy J Revilla
- Division of Neurology at Greenville Health System and the University of South Carolina Medical School-Greenville, Greenville, SC, USA
| | - Johnna Devoto
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Dora Yearout
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Shu-Ching Hu
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Brenna A Cholerton
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Thomas J Montine
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Karen L Edwards
- Department of Epidemiology, School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Cyrus P Zabetian
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA.
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Abstract
Dementia is a frequent problem encountered in advanced stages of Parkinson disease (PD). In recent years, research has focused on the pre-dementia stages of cognitive impairment in PD, including mild cognitive impairment (MCI). Several longitudinal studies have shown that MCI is a harbinger of dementia in PD, although the course is variable, and stabilization of cognition - or even reversal to normal cognition - is not uncommon. In addition to limbic and cortical spread of Lewy pathology, several other mechanisms are likely to contribute to cognitive decline in PD, and a variety of biomarker studies, some using novel structural and functional imaging techniques, have documented in vivo brain changes associated with cognitive impairment. The evidence consistently suggests that low cerebrospinal fluid levels of amyloid-β42, a marker of comorbid Alzheimer disease (AD), predict future cognitive decline and dementia in PD. Emerging genetic evidence indicates that in addition to the APOE*ε4 allele (an established risk factor for AD), GBA mutations and SCNA mutations and triplications are associated with cognitive decline in PD, whereas the findings are mixed for MAPT polymorphisms. Cognitive enhancing medications have some effect in PD dementia, but no convincing evidence that progression from MCI to dementia can be delayed or prevented is available, although cognitive training has shown promising results.
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Koros C, Simitsi A, Stefanis L. Genetics of Parkinson's Disease: Genotype-Phenotype Correlations. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:197-231. [PMID: 28554408 DOI: 10.1016/bs.irn.2017.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since the first discovery of a specific genetic defect in the SNCA gene, encoding for α-synuclein, as a causative factor for Parkinson's disease 20 years ago, a multitude of other genes have been linked to this disease in rare cases with Mendelian inheritance. Furthermore, the genetic contribution to the much more common sporadic disease has been demonstrated through case control association studies and, more recently, genome-wide association studies. Interestingly, some of the genes with Mendelian inheritance, such as SNCA, are also relevant to the sporadic disease, suggesting common pathogenetic mechanisms. In this review, we place an emphasis on Mendelian forms, and in particular genetic defects which present predominantly with Parkinsonism. We provide details into the particular phenotypes associated with each genetic defect, with a particular emphasis on nonmotor symptoms. For genetic defects for whom a sufficient number of patients has been assessed, there are evident genotype-phenotype correlations. However, it should be noted that patients with the same causative mutation may present with distinctly divergent phenotypes. This phenotypic variability may be due to genetic, epigenetic or environmental factors. From a clinical and genetic point of view, it will be especially interesting in the future to identify genetic factors that modify disease penetrance, the age of onset or other specific phenotypic features.
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Affiliation(s)
- Christos Koros
- National and Kapodistrian University of Athens Medical School, "Attikon" Hospital, Athens, Greece
| | - Athina Simitsi
- National and Kapodistrian University of Athens Medical School, "Attikon" Hospital, Athens, Greece
| | - Leonidas Stefanis
- National and Kapodistrian University of Athens Medical School, "Attikon" Hospital, Athens, Greece.
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Fagan ES, Pihlstrøm L. Genetic risk factors for cognitive decline in Parkinson's disease: a review of the literature. Eur J Neurol 2017; 24:561-e20. [DOI: 10.1111/ene.13258] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/11/2017] [Indexed: 01/18/2023]
Affiliation(s)
- E. S. Fagan
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - L. Pihlstrøm
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Neurology; Oslo University Hospital; Oslo Norway
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125
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Glucosylceramide synthase inhibition alleviates aberrations in synucleinopathy models. Proc Natl Acad Sci U S A 2017; 114:2699-2704. [PMID: 28223512 DOI: 10.1073/pnas.1616152114] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mutations in the glucocerebrosidase gene (GBA) confer a heightened risk of developing Parkinson's disease (PD) and other synucleinopathies, resulting in a lower age of onset and exacerbating disease progression. However, the precise mechanisms by which mutations in GBA increase PD risk and accelerate its progression remain unclear. Here, we investigated the merits of glucosylceramide synthase (GCS) inhibition as a potential treatment for synucleinopathies. Two murine models of synucleinopathy (a Gaucher-related synucleinopathy model, GbaD409V/D409V and a A53T-α-synuclein overexpressing model harboring wild-type alleles of GBA, A53T-SNCA mouse model) were exposed to a brain-penetrant GCS inhibitor, GZ667161. Treatment of GbaD409V/D409V mice with the GCS inhibitor reduced levels of glucosylceramide and glucosylsphingosine in the central nervous system (CNS), demonstrating target engagement. Remarkably, treatment with GZ667161 slowed the accumulation of hippocampal aggregates of α-synuclein, ubiquitin, and tau, and improved the associated memory deficits. Similarly, prolonged treatment of A53T-SNCA mice with GZ667161 reduced membrane-associated α-synuclein in the CNS and ameliorated cognitive deficits. The data support the contention that prolonged antagonism of GCS in the CNS can affect α-synuclein processing and improve behavioral outcomes. Hence, inhibition of GCS represents a disease-modifying therapeutic strategy for GBA-related synucleinopathies and conceivably for certain forms of sporadic disease.
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126
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Barkhuizen M, Anderson DG, van der Westhuizen FH, Grobler AF. A molecular analysis of the GBA gene in Caucasian South Africans with Parkinson's disease. Mol Genet Genomic Med 2017; 5:147-156. [PMID: 28361101 PMCID: PMC5370228 DOI: 10.1002/mgg3.267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/16/2016] [Accepted: 11/22/2016] [Indexed: 01/07/2023] Open
Abstract
Background The molecular basis of Parkinson's disease in South African population groups remains elusive. To date, substitutions in the GBA gene are the most common large‐effect genetic risk factor for Parkinson's disease. The primary objective of this study was to determine the prevalence of GBA substitutions in South Africans with idiopathic Parkinson's disease. Methods Participants were recruited from tertiary hospitals in the Gauteng Province in South Africa. All participants were screened for substitutions in GBA exon 8‐11 and the full coding region was analysed in 20 participants. Peripheral β‐glucocerebrosidase enzymatic activity of GBA‐carriers was measured in mixed leukocytes. Results Of 105 Caucasian Parkinson's disease participants (82.7% Afrikaner) with an average age of disease onset of 61.9 ± 12.2 years and 40 controls (age 73.4 ± 12.4 years) were included. Heterozygous GBA substitutions were identified in 12.38% of affected participants (p.G35A, p.E326K, p.I368T, p.T369M, p.N370S, p.P387L and p.K441N) and 5.00% of controls (p.E326K and p.T369M). The substitutions ranged from predicted benign to moderately damaging; with p.E326K and p.T369M most prevalent, followed by the Afrikaner Gaucher disease substitution p.P387L. Severe Gaucher disease mutations, like p.L444P, were absent in this cohort. Enzyme activity analysis revealed a nonsignificant reduction in the GBA‐Parkinson's disease individuals (14.49 ± 2.30 nmol/h/mg protein vs. 15.98 ± 3.06 nmol/h/mg in control samples). GBA substitutions occur in both young‐onset and late‐onset Parkinson's cases in the cohort. Conclusion Mild GBA substitutions that may not cause Gaucher disease were a common risk factor for Parkinson's disease in the participant group.
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Affiliation(s)
- Melinda Barkhuizen
- DST/NWU Preclinical Drug Development PlatformNorth-West UniversityPotchefstroom2520South Africa; Department of PaediatricsSchool for Mental Health and NeuroscienceMaastricht UniversityMaastricht6229The Netherlands
| | - David G Anderson
- Department of Neurology University of the Witwatersrand Donald Gordon Medical Centre Johannesburg 2193 South Africa
| | | | - Anne F Grobler
- DST/NWU Preclinical Drug Development Platform North-West University Potchefstroom 2520 South Africa
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Affiliation(s)
- Jessica M. Mc Donald
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611-4296; ,
| | - Dimitri Krainc
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611-4296; ,
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Kasten M, Marras C, Klein C. Nonmotor Signs in Genetic Forms of Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:129-178. [DOI: 10.1016/bs.irn.2017.05.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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129
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Lim EW, Tan EK. Genes and Nonmotor Symptoms in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:111-127. [DOI: 10.1016/bs.irn.2017.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Mallik AK, Drzezga A, Minoshima S. Molecular Imaging and Precision Medicine in Dementia and Movement Disorders. PET Clin 2017; 12:119-136. [DOI: 10.1016/j.cpet.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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131
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Swan M, Doan N, Ortega RA, Barrett M, Nichols W, Ozelius L, Soto-Valencia J, Boschung S, Deik A, Sarva H, Cabassa J, Johannes B, Raymond D, Marder K, Giladi N, Miravite J, Severt W, Sachdev R, Shanker V, Bressman S, Saunders-Pullman R. Neuropsychiatric characteristics of GBA-associated Parkinson disease. J Neurol Sci 2016; 370:63-69. [PMID: 27772789 PMCID: PMC5268078 DOI: 10.1016/j.jns.2016.08.059] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/22/2016] [Accepted: 08/29/2016] [Indexed: 12/29/2022]
Abstract
Mutations in GBA1 are a well-established risk factor for Parkinson disease (PD). GBA-associated PD (GBA-PD) may have a higher burden of nonmotor symptoms than idiopathic PD (IPD). We sought to characterize the relationship between GBA-PD and neuropsychiatric symptoms. Subjects were screened for common GBA1 mutations. GBA-PD (n=31) and non-carrier (IPD; n=55) scores were compared on the Unified Parkinson Disease Rating Scale (UPDRS), Montreal Cognitive Assessment (MoCA), Beck Depression Inventory (BDI), and the State-Trait Anxiety Index (STAI). In univariate comparisons, GBA-PD had a greater prevalence of depression (33.3%) versus IPD (13.2%) (p<0.05). In regression models controlling for age, sex, disease duration, motor disability, and MoCA score, GBA-PD had an increased odds of depression (OR 3.66, 95% CI 1.13-11.8) (p=0.03). Post-hoc analysis stratified by sex showed that, among men, GBA-PD had a higher burden of trait anxiety and depression than IPD; this finding was sustained in multivariate models. Among women, GBA-PD did not confer greater psychiatric morbidity than IPD. These results suggest that GBA1 mutations confer greater risk of neuropsychiatric morbidity in PD, and that sex may affect this association.
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Affiliation(s)
- Matthew Swan
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA; Department of Neurology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
| | - Nancy Doan
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Robert A Ortega
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Matthew Barrett
- Department of Neurology, University of Virginia Health System, Charlottesville, VA, USA.
| | - William Nichols
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Laurie Ozelius
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Jeannie Soto-Valencia
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Sarah Boschung
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Andres Deik
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA.
| | - Harini Sarva
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA.
| | - Jose Cabassa
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA.
| | - Brooke Johannes
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Deborah Raymond
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Karen Marder
- Department of Neurology and Psychiatry, Taub Institute, and Sergievsky Center, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Center, Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel.
| | - Joan Miravite
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - William Severt
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Rivka Sachdev
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Vicki Shanker
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Susan Bressman
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel, and Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA.
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Hong JH, Kim YK, Park JS, Lee JE, Oh MS, Chung EJ, Kim JY, Sung YH, Lyoo CH, Lee JH, Kwon DY, Kim HS, Shin HW, Park SA, Park IS, Kim JS, Lee PH, Koh SB, Baik JS, Kim SJ, Ma HI, Kim JW, Kim YJ. Lack of association between LRRK2 G2385R and cognitive dysfunction in Korean patients with Parkinson's disease. J Clin Neurosci 2016; 36:108-113. [PMID: 27839916 DOI: 10.1016/j.jocn.2016.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/15/2016] [Indexed: 01/22/2023]
Abstract
Aside from the glucocerebrosidase gene, the genetic risk factors for cognitive decline in Parkinson's disease (PD) are controversial. We investigated whether the G2385R polymorphism in leucine-rich repeat kinase 2 gene (LRRK2), a risk variant for the development of PD in East Asians, is associated with cognitive dysfunction in PD. We recruited 299 PD patients, consisting of 23 carriers and 276 non-carriers of LRRK2 G2385R, from 14 centers. Global cognitive function was assessed using the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA). PD with cognitive dysfunction was defined as an MMSE Z score that, adjusting for age at study entry and years of education, was below -1.0 standard deviations. In multivariate analysis, PD duration, age at study entry and depression were significant risk factors for cognitive dysfunction as assessed by MMSE performance or the MoCA. In linear regression analysis of the association between MMSE Z scores and PD duration, there was no significant difference associated with the LRRK2 G2385R genotype. The interaction terms between PD duration and the LRRK2 G2385R genotype were not significant for the MMSE Z score but were significant for the MoCA. In conclusion, the LRRK2 G2385R genotype may not be associated with cognitive dysfunction in PD.
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Affiliation(s)
- Jeong Hoon Hong
- ILSONG Institute of Life Science, Hallym University, Anyang, South Korea
| | - Yue Kyung Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Jae Seol Park
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Ji Eun Lee
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Ilsan, South Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Eun Joo Chung
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jeong-Yeon Kim
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Young-Hee Sung
- Department of Neurology, Gachon University College of Medicine, Incheon, South Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Hyeok Lee
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Do-Young Kwon
- Department of Neurology, Korea University College of Medicine, Ansan Hospital, Ansan, South Korea
| | - Hyun Sook Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Hae-Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sun Ah Park
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - In-Seok Park
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University College of Medicine at Guro Hospital, Seoul, South Korea
| | - Jong Sam Baik
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Sang Jin Kim
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Hyeo-Il Ma
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Jae Woo Kim
- Department of Neurology, Dong-A University School of Medicine, Busan, South Korea
| | - Yun Joong Kim
- ILSONG Institute of Life Science, Hallym University, Anyang, South Korea; Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea; Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang, South Korea.
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Safarpour D, Willis AW. Clinical Epidemiology, Evaluation, and Management of Dementia in Parkinson Disease. Am J Alzheimers Dis Other Demen 2016; 31:585-594. [PMID: 27295974 PMCID: PMC10852884 DOI: 10.1177/1533317516653823] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The prevalence of neurodegenerative diseases such as Parkinson disease (PD) will increase substantially, due to the aging of the population and improved treatments leading to better disease-related outcomes. Dementia is the most common nonmotor symptom in PD, and most patients with PD will have cognitive dysfunction and cognitive decline in the course of their disease. The development of cognitive dysfunction in PD greatly limits the ability to participate in activities of daily living and can be a tipping point for nursing home placement or major caregiver stress. Understanding the different causes of dementia and how to reduce the incidence and impact of secondary cognitive dysfunction in PD are necessary skills for primary care physicians and neurologists. In this review, we discuss the clinical epidemiology of dementia in PD with an emphasis on preventable cognitive dysfunction, present tools for outpatient evaluation of cognitive dysfunction, and describe current pharmacological treatments for dementia in PD.
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Affiliation(s)
- Delaram Safarpour
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Parkinson's Disease Research, Education and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Allison W Willis
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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134
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Corvol JC, Poewe W. Pharmacogenetics of Parkinson's Disease in Clinical Practice. Mov Disord Clin Pract 2016; 4:173-180. [PMID: 30363349 DOI: 10.1002/mdc3.12444] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/12/2016] [Accepted: 08/29/2016] [Indexed: 12/13/2022] Open
Abstract
Background Pharmacogenetics aims to identify the genetic factors participating in the heterogeneity of drug response. The ultimate goal is to provide personalized treatment by identifying responders and non-responders, individuals at risk of developing drug adverse effects, and by adjusting dosage. Several studies have been performed in Parkinson's disease (PD), to investigate drug response variability according to genetic factors for dopamine replacement therapies. Methods We performed a systematic literature search of articles related to pharmacogenetic studies in PD, and found 47 studies. Findings Motor response and adverse reactions to dopaminergic drugs were associated with genes encoding enzymes of their metabolism as well as their receptors or targets. Despite some interesting results, considerable work remains to be done to replicate and validate their clinical relevance before translation into clinical practice. Conclusions There are currently no guidelines published for pharmacogenetic factors related to PD drugs. More research is need in this field in order to improve our knowledge in drug response variability in PD. Algorithms taking into account clinical, pharmacological, and genetic factors are probably the most promising way to help for a personalized medicine in PD.
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Affiliation(s)
- Jean-Christophe Corvol
- Sorbonne Universités UPMC Univ Paris 06 UMR_S1127 ICM Paris France.,INSERM UMR_S1127 and CIC-1422 ICM Paris France.,CNRS UMR_7225 ICM Paris France.,Département des maladies du système nerveux AP-HP Hôpital Pitié-Salpêtrière Paris France
| | - Werner Poewe
- Department of Neurology Medical University Innsbruck Innsbruck Austria
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135
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Weil RS, Schrag AE, Warren JD, Crutch SJ, Lees AJ, Morris HR. Visual dysfunction in Parkinson's disease. Brain 2016; 139:2827-2843. [PMID: 27412389 PMCID: PMC5091042 DOI: 10.1093/brain/aww175] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/23/2016] [Accepted: 06/05/2016] [Indexed: 01/09/2023] Open
Abstract
Patients with Parkinson's disease have a number of specific visual disturbances. These include changes in colour vision and contrast sensitivity and difficulties with complex visual tasks such as mental rotation and emotion recognition. We review changes in visual function at each stage of visual processing from retinal deficits, including contrast sensitivity and colour vision deficits to higher cortical processing impairments such as object and motion processing and neglect. We consider changes in visual function in patients with common Parkinson's disease-associated genetic mutations including GBA and LRRK2 . We discuss the association between visual deficits and clinical features of Parkinson's disease such as rapid eye movement sleep behavioural disorder and the postural instability and gait disorder phenotype. We review the link between abnormal visual function and visual hallucinations, considering current models for mechanisms of visual hallucinations. Finally, we discuss the role of visuo-perceptual testing as a biomarker of disease and predictor of dementia in Parkinson's disease.
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Affiliation(s)
- Rimona S. Weil
- 1 Institute of Neurology, University College London, London, UK
- 2 National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- 3 Department of Clinical Neurosciences, Royal Free Hospital NHS Trust, London, UK
| | - Anette E. Schrag
- 1 Institute of Neurology, University College London, London, UK
- 2 National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Jason D. Warren
- 2 National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- 4 Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Sebastian J. Crutch
- 4 Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Andrew J. Lees
- 1 Institute of Neurology, University College London, London, UK
- 2 National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Huw R. Morris
- 1 Institute of Neurology, University College London, London, UK
- 2 National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- 3 Department of Clinical Neurosciences, Royal Free Hospital NHS Trust, London, UK
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136
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Gao R, Zhang G, Chen X, Yang A, Smith G, Wong DF, Zhou Y. CSF Biomarkers and Its Associations with 18F-AV133 Cerebral VMAT2 Binding in Parkinson's Disease-A Preliminary Report. PLoS One 2016; 11:e0164762. [PMID: 27764160 PMCID: PMC5072678 DOI: 10.1371/journal.pone.0164762] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/30/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cerebrospinal fluid (CSF) biomarkers, such as α-synuclein (α-syn), amyloid beta peptide 1-42 (Aβ1-42), phosphorylated tau (181P) (p-tau), and total tau (t-tau), have long been associated with the development of Parkinson disease (PD) and other neurodegenerative diseases. In this investigation, we reported the assessment of CSF biomarkers and their correlations with vesicular monoamine transporter 2 (VMAT2) bindings measured with 18F-9-fluoropropyl-(+)-dihydrotetrabenazine (18F-AV133) that is being developed as a biomarker for PD. We test the hypothesis that monoaminergic degeneration was correlated with CSF biomarker levels in untreated PD patients. METHODS The available online data from the Parkinson's Progression Markers Initiative study (PPMI) project were collected and analyzed, which include demographic information, clinical evaluations, CSF biomarkers (α-syn, Aβ1-42, p-tau, and t-tau), 18F-AV133 brain PET, and T1 weighted MRIs. Region of interest (ROI) and voxel-wise Pearson correlation between standardized uptake value ratio (SUVR) and CSF biomarkers were calculated. RESULTS Our major findings are: 1) Compared with controls, CSF α-syn and tau levels decreased significantly in PD; 2) α-syn was closely correlated with Aβ1-42 and tau in PD, especially in early-onset patients; and 3) hypothesis-driven ROI analysis found a significant negative correlation between CSF Aβ1-42 levels and VMAT2 densities in post cingulate, left caudate, left anterior putamen, and left ventral striatum in PDs. CSF t-tau and p-tau levels were significantly negatively related to VMAT2 SUVRs in substantia nigra and left ventral striatum, respectively. Voxel-wise analysis showed that left caudate, parahippocampal gyrus, insula and temporal lobe were negatively correlated with Aβ1-42. In addition, superior frontal gyrus and transverse temporal gyrus were negatively correlated with CSF p-tau levels. CONCLUSION These results suggest that monoaminergic degeneration in PD is correlated with CSF biomarkers associated with cognitive impairment in neurodegenerative diseases including Alzheimer's disease. The association between loss of dopamine synaptic function and pathologic protein accumulations in PD indicates an important role of CSF biomarkers in PD development.
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Affiliation(s)
- Rui Gao
- Department of Nuclear Medicine, the First Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi 710061, China
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, United States of America
| | - Guangjian Zhang
- Department of Surgery, the First Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Xueqi Chen
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, United States of America
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Aimin Yang
- Department of Nuclear Medicine, the First Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Gwenn Smith
- Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21287, United States of America
| | - Dean F. Wong
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, United States of America
- Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland 21205, United States of America
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland 21205, United States of America
- Department of Neuroscience, Johns Hopkins University, Baltimore, Maryland 21205, United States of America
| | - Yun Zhou
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, United States of America
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Cilia R, Tunesi S, Marotta G, Cereda E, Siri C, Tesei S, Zecchinelli AL, Canesi M, Mariani CB, Meucci N, Sacilotto G, Zini M, Barichella M, Magnani C, Duga S, Asselta R, Soldà G, Seresini A, Seia M, Pezzoli G, Goldwurm S. Survival and dementia inGBA-associated Parkinson's disease: The mutation matters. Ann Neurol 2016; 80:662-673. [DOI: 10.1002/ana.24777] [Citation(s) in RCA: 249] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Roberto Cilia
- Parkinson Institute, ASST “Gaetano Pini-CTO”; Milan Italy
| | - Sara Tunesi
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology; University of Piemonte Orientale; Novara Italy
- Center for Cancer Epidemiology and Prevention (CPO); University Hospital “Città della Salute e della Scienza di Torino”; Turin Italy
| | - Giorgio Marotta
- Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
| | | | - Chiara Siri
- Parkinson Institute, ASST “Gaetano Pini-CTO”; Milan Italy
| | - Silvana Tesei
- Parkinson Institute, ASST “Gaetano Pini-CTO”; Milan Italy
| | | | | | | | | | | | - Michela Zini
- Parkinson Institute, ASST “Gaetano Pini-CTO”; Milan Italy
| | | | - Corrado Magnani
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology; University of Piemonte Orientale; Novara Italy
| | - Stefano Duga
- Department of Biomedical Sciences; Humanitas University, Rozzano, Milan, Italy; and Humanitas Clinical and Research Center; Rozzano Milan Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences; Humanitas University, Rozzano, Milan, Italy; and Humanitas Clinical and Research Center; Rozzano Milan Italy
| | - Giulia Soldà
- Department of Biomedical Sciences; Humanitas University, Rozzano, Milan, Italy; and Humanitas Clinical and Research Center; Rozzano Milan Italy
| | - Agostino Seresini
- Molecular Genetics Laboratory, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - Manuela Seia
- Molecular Genetics Laboratory, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - Gianni Pezzoli
- Parkinson Institute, ASST “Gaetano Pini-CTO”; Milan Italy
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Dai M, Liou B, Swope B, Wang X, Zhang W, Inskeep V, Grabowski GA, Sun Y, Pan D. Progression of Behavioral and CNS Deficits in a Viable Murine Model of Chronic Neuronopathic Gaucher Disease. PLoS One 2016; 11:e0162367. [PMID: 27598339 PMCID: PMC5012639 DOI: 10.1371/journal.pone.0162367] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 08/22/2016] [Indexed: 12/12/2022] Open
Abstract
To study the neuronal deficits in neuronopathic Gaucher Disease (nGD), the chronological behavioral profiles and the age of onset of brain abnormalities were characterized in a chronic nGD mouse model (9V/null). Progressive accumulation of glucosylceramide (GC) and glucosylsphingosine (GS) in the brain of 9V/null mice were observed at as early as 6 and 3 months of age for GC and GS, respectively. Abnormal accumulation of α-synuclein was present in the 9V/null brain as detected by immunofluorescence and Western blot analysis. In a repeated open-field test, the 9V/null mice (9 months and older) displayed significantly less environmental habituation and spent more time exploring the open-field than age-matched WT group, indicating the onset of short-term spatial memory deficits. In the marble burying test, the 9V/null group had a shorter latency to initiate burying activity at 3 months of age, whereas the latency increased significantly at ≥12 months of age; 9V/null females buried significantly more marbles to completion than the WT group, suggesting an abnormal response to the instinctive behavior and an abnormal activity in non-associative anxiety-like behavior. In the conditional fear test, only the 9V/null males exhibited a significant decrease in response to contextual fear, but both genders showed less response to auditory-cued fear compared to age- and gender-matched WT at 12 months of age. These results indicate hippocampus-related emotional memory defects. Abnormal gait emerged in 9V/null mice with wider front-paw and hind-paw widths, as well as longer stride in a gender-dependent manner with different ages of onset. Significantly higher liver- and spleen-to-body weight ratios were detected in 9V/null mice with different ages of onsets. These data provide temporal evaluation of neurobehavioral dysfunctions and brain pathology in 9V/null mice that can be used for experimental designs to evaluate novel therapies for nGD.
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Affiliation(s)
- Mei Dai
- Experimental Hematology and Cancer Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Benjamin Liou
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Brittany Swope
- Experimental Hematology and Cancer Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States of America
| | - Xiaohong Wang
- Experimental Hematology and Cancer Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Wujuan Zhang
- Division of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Venette Inskeep
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Gregory A. Grabowski
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Ying Sun
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States of America
| | - Dao Pan
- Experimental Hematology and Cancer Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States of America
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Abstract
PURPOSE OF REVIEW While the distinctive motor symptoms of Parkinson disease (PD) have been described for centuries, cognitive impairment has only recently been recognized as a central feature. Studies have yielded clues to the etiology and natural history of cognitive impairment in PD, but much remains unclear and effective therapies are needed. RECENT FINDINGS Longitudinal cohort studies demonstrate that almost all patients with PD will develop dementia if they live long enough. New CSF biomarker and genetic studies suggest that it may soon be possible to forecast and track the progression of dementia in PD. Sleep and sleep disturbance appear to be intrinsically linked with PD, although the implications for individual outcomes and opportunities for intervention are unclear. Multidisciplinary treatment approaches incorporating cognitive training may help to improve outcomes. SUMMARY We review several recent advances in understanding the pathophysiology, genetics, and management of cognitive impairment in PD.
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Affiliation(s)
- Albert A Davis
- Department of Neurology (AAD, BR), Washington University School of Medicine, St. Louis, MO; and School of Public Health (BR), University of the Witwatersrand, Johannesburg, South Africa
| | - Brad Racette
- Department of Neurology (AAD, BR), Washington University School of Medicine, St. Louis, MO; and School of Public Health (BR), University of the Witwatersrand, Johannesburg, South Africa
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Bregman N, Thaler A, Mirelman A, Helmich RC, Gurevich T, Orr-Urtreger A, Marder K, Bressman S, Bloem BR, Giladi N. A cognitive fMRI study in non-manifesting LRRK2 and GBA carriers. Brain Struct Funct 2016; 222:1207-1218. [PMID: 27401793 DOI: 10.1007/s00429-016-1271-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
Mutations in the GBA and LRRK2 genes account for one-third of the prevalence of Parkinson's disease (PD) in Ashkenazi Jews. Non-manifesting carriers (NMC) of these mutations represent a population at risk for future development of PD. PD patient who carry mutations in the GBA gene demonstrates more significant cognitive decline compared to idiopathic PD patients. We assessed cognitive domains using fMRI among NMC of both LRRK2 and GBA mutations to better understand pre-motor cognitive functions in these populations. Twenty-one LRRK2-NMC, 10 GBA-NMC, and 22 non-manifesting non-carriers (NMNC) who participated in this study were evaluated using the standard questionnaires and scanned while performing two separate cognitive tasks; a Stroop interference task and an N-Back working memory task. Cerebral activation patterns were assessed using both whole brain and predefined region of interest (ROI) analysis. Subjects were well matched in all demographic and clinical characteristics. On the Stroop task, in spite of similar behavior, GBA-NMC demonstrated increased task-related activity in the right medial frontal gyrus and reduced task-related activity in the left lingual gyrus compared to both LRRK2-NMC and NMNC. In addition, GBA-NMC had higher activation patterns in the incongruent task compared to NMNC in the left medial frontal gyrus and bilateral precentral gyrus. No whole-brain differences were noted between groups on the N-Back task. Paired cognitive and task-related performance between GBA-NMC, LRRK2-NMC, and NMNC could indicate that the higher activation patterns in the incongruent Stroop condition among GBA-NMC compared to LRRK2-NMC and NMNC may represent a compensatory mechanism that enables adequate cognitive performance.
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Affiliation(s)
- Noa Bregman
- Department of Neurology, Memory and Attention Disorders Center, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Avner Thaler
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Medical Center, 6 Weizman Street, 64239, Tel-Aviv, Israel. .,Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel. .,Functional Brain Center, Wohl Institute for Advanced Imaging, Tel-Aviv Medical Center, Tel-Aviv, Israel.
| | - Anat Mirelman
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Medical Center, 6 Weizman Street, 64239, Tel-Aviv, Israel.,Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Rick C Helmich
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Tanya Gurevich
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Medical Center, 6 Weizman Street, 64239, Tel-Aviv, Israel.,Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Avi Orr-Urtreger
- Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Genetic Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Karen Marder
- Columbia University Medical Center, Columbia University, New York, NY, USA
| | | | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Nir Giladi
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Medical Center, 6 Weizman Street, 64239, Tel-Aviv, Israel.,Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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141
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Delgado-Alvarado M, Gago B, Navalpotro-Gomez I, Jiménez-Urbieta H, Rodriguez-Oroz MC. Biomarkers for dementia and mild cognitive impairment in Parkinson's disease. Mov Disord 2016; 31:861-81. [PMID: 27193487 DOI: 10.1002/mds.26662] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/15/2016] [Accepted: 04/18/2016] [Indexed: 12/27/2022] Open
Abstract
Cognitive decline is one of the most frequent and disabling nonmotor features of Parkinson's disease. Around 30% of patients with Parkinson's disease experience mild cognitive impairment, a well-established risk factor for the development of dementia. However, mild cognitive impairment in patients with Parkinson's disease is a heterogeneous entity that involves different types and extents of cognitive deficits. Because it is not currently known which type of mild cognitive impairment confers a higher risk of progression to dementia, it would be useful to define biomarkers that could identify these patients to better study disease progression and possible interventions. In this sense, the identification among patients with Parkinson's disease and mild cognitive impairment of biomarkers associated with dementia would allow the early detection of this process. This review summarizes studies from the past 25 years that have assessed the potential biomarkers of dementia and mild cognitive impairment in Parkinson's disease patients. Despite the potential importance, no biomarker has as yet been validated. However, features such as low levels of epidermal and insulin-like growth factors or uric acid in plasma/serum and of Aß in CSF, reduction of cerebral cholinergic innervation and metabolism measured by PET mainly in posterior areas, and hippocampal atrophy in MRI might be indicative of distinct deficits with a distinct risk of dementia in subgroups of patients. Longitudinal studies combining the existing techniques and new approaches are needed to identify patients at higher risk of dementia. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Manuel Delgado-Alvarado
- Biodonostia Health Research Institute, San Sebastián, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Belén Gago
- Biodonostia Health Research Institute, San Sebastián, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Irene Navalpotro-Gomez
- Biodonostia Health Research Institute, San Sebastián, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Haritz Jiménez-Urbieta
- Biodonostia Health Research Institute, San Sebastián, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - María C Rodriguez-Oroz
- Biodonostia Health Research Institute, San Sebastián, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Neurology Department, University Hospital Donostia, San Sebastián, Spain.,Ikerbasque (Basque Foundation for Science), Bilbao, Spain.,Basque Center on Cognition, Brain and Language (BCBL), San Sebastián, Spain.,Physiology Department, Medical School University of Navarra, Pamplona, Spain
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142
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Giladi N, Mirelman A, Thaler A, Orr-Urtreger A. A Personalized Approach to Parkinson's Disease Patients Based on Founder Mutation Analysis. Front Neurol 2016; 7:71. [PMID: 27242656 PMCID: PMC4861838 DOI: 10.3389/fneur.2016.00071] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 04/25/2016] [Indexed: 12/20/2022] Open
Abstract
While the phenotype of Parkinson disease (PD) is heterogeneous, treatment approaches are mostly uniform. Personalized medicine aims to treat diseases with targeted therapies based on cumulative variables, including genotype. We believe that sufficient evidence has accumulated to warrant the initiation of personalized medicine in PD based on subjects genotype and provide examples for our reasoning from observations of GBA and LRRK2 mutations carriers. While PD patients who carry the G2019S mutation in the LRRK2 gene seem to develop relatively mild disease with more frequent postural instability gait disturbance phenotype, carriers of mutations in the GBA gene tend to have an early onset, rapidly deteriorating disease, with more pronounced cognitive and autonomic impairments. These characteristics have significant implications for treatment and outcome and should be addressed from an early stage in the attempt to improve the patient's quality of life.
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Affiliation(s)
- Nir Giladi
- Laboratory for Early Markers of Neurodegeneration, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Thaler
- Laboratory for Early Markers of Neurodegeneration, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Orr-Urtreger
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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143
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Kim HJ, Jeon B. How close are we to individualized medicine for Parkinson's disease? Expert Rev Neurother 2016; 16:815-30. [PMID: 27105072 DOI: 10.1080/14737175.2016.1182021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION There is a considerable inter-individual heterogeneity in clinical features, disease course, and treatment response in Parkinson's disease (PD), which can be explained not only by disease process and clinical variables, but also by an impact from genetic factors. Evidence-based medicine relies on large randomized control trials and meta-analysis-average medicine, which ignores individual differences. However, we are now in the early phases of a paradigm shift in medicine relating to individuality and variability. The purpose of individualized medicine is to predict patients' responses to targeted therapy using diagnostic tests based on genetics or other molecular mechanisms, thus providing the right drug at the right dose at the right time. AREAS COVERED In this article, we outline current state of individualized medicine for PD. Expert Commentary: Pharmacogenomics, an important element of individualized medicine, is just beginning to be considered in PD. To advance the clinical use of pharmacogenomics, big data cohort for genomic research and multidisciplinary team approaches are necessary.
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Affiliation(s)
- Hee Jin Kim
- a Department of Neurology , Konkuk University Medical Center , Seoul , South Korea.,b Parkinson Disease Study Group , Seoul National University Hospital , Seoul , South Korea
| | - Beomseok Jeon
- a Department of Neurology , Konkuk University Medical Center , Seoul , South Korea.,c Department of Neurology and Movement Disorder Center, College of Medicine , Seoul National University , Seoul , South Korea
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144
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Ran C, Brodin L, Forsgren L, Westerlund M, Ramezani M, Gellhaar S, Xiang F, Fardell C, Nissbrandt H, Söderkvist P, Puschmann A, Ygland E, Olson L, Willows T, Johansson A, Sydow O, Wirdefeldt K, Galter D, Svenningsson P, Belin AC. Strong association between glucocerebrosidase mutations and Parkinson's disease in Sweden. Neurobiol Aging 2016; 45:212.e5-212.e11. [PMID: 27255555 PMCID: PMC4982543 DOI: 10.1016/j.neurobiolaging.2016.04.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/06/2016] [Accepted: 04/26/2016] [Indexed: 01/14/2023]
Abstract
Several genetic studies have demonstrated an association between mutations in glucocerebrosidase (GBA), originally implicated in Gaucher's disease, and an increased risk of Parkinson's disease (PD). We have investigated the possible involvement of genetic GBA variations in PD in the Swedish population. Three GBA variants, E326K, N370S, and L444P were screened in the largest Swedish Parkinson cohort reported to date; 1625 cases and 2025 control individuals. We found a significant association with high effect size of the rare variant L444P with PD (odds ratio 8.17; 95% confidence interval: 2.51-26.23; p-value = 0.0020) and a significant association of the common variant E326K (odds ratio 1.60; 95% confidence interval: 1.16-2.22; p-value = 0.026). The rare variant N370S showed a trend for association. Most L444P carriers (68%) were found to reside in northern Sweden, which is consistent with a higher prevalence of Gaucher's disease in this part of the country. Our findings support the role of GBA mutations as risk factors for PD and point to lysosomal dysfunction as a mechanism contributing to PD etiology.
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Affiliation(s)
- Caroline Ran
- Department of Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Lovisa Brodin
- Department of Clinical Neuroscience, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Forsgren
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Marie Westerlund
- Department of Neuroscience, Karolinska Institutet, Solna, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | | | - Sandra Gellhaar
- Department of Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Fengqing Xiang
- Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Camilla Fardell
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Nissbrandt
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Söderkvist
- Faculty of Health Sciences, Division of Cell Biology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Andreas Puschmann
- Department of Neurology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences Lund, Neurology, Skane University Hospital, Lund University, Lund, Sweden
| | - Emil Ygland
- Department of Clinical Sciences Lund, Neurology, Skane University Hospital, Lund University, Lund, Sweden
| | - Lars Olson
- Department of Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Thomas Willows
- Department of Clinical Neuroscience, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Johansson
- Department of Clinical Neuroscience, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Sydow
- Department of Clinical Neuroscience, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Wirdefeldt
- Department of Clinical Neuroscience, Karolinska University Hospital, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Dagmar Galter
- Department of Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Karolinska University Hospital, Stockholm, Sweden
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145
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Rockenstein E, Clarke J, Viel C, Panarello N, Treleaven CM, Kim C, Spencer B, Adame A, Park H, Dodge JC, Cheng SH, Shihabuddin LS, Masliah E, Sardi SP. Glucocerebrosidase modulates cognitive and motor activities in murine models of Parkinson's disease. Hum Mol Genet 2016; 25:2645-2660. [PMID: 27126635 PMCID: PMC5181635 DOI: 10.1093/hmg/ddw124] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 04/08/2016] [Accepted: 04/18/2016] [Indexed: 12/11/2022] Open
Abstract
Mutations in GBA1, the gene encoding glucocerebrosidase, are associated with an enhanced risk of developing synucleinopathies such as Parkinson’s disease (PD) and dementia with Lewy bodies. A higher prevalence and increased severity of motor and non-motor symptoms is observed in PD patients harboring mutant GBA1 alleles, suggesting a link between the gene or gene product and disease development. Interestingly, PD patients without mutations in GBA1 also exhibit lower levels of glucocerebrosidase activity in the central nervous system (CNS), implicating this lysosomal enzyme in disease pathogenesis. Here, we investigated whether modulation of glucocerebrosidase activity in murine models of synucleinopathy (expressing wild type Gba1) affected α-synuclein accumulation and behavioral phenotypes. Partial inhibition of glucocerebrosidase activity in PrP-A53T-SNCA mice using the covalent inhibitor conduritol-B-epoxide induced a profound increase in soluble α-synuclein in the CNS and exacerbated cognitive and motor deficits. Conversely, augmenting glucocerebrosidase activity in the Thy1-SNCA mouse model of PD delayed the progression of synucleinopathy. Adeno-associated virus-mediated expression of glucocerebrosidase in the Thy1-SNCA mouse striatum led to decrease in the levels of the proteinase K-resistant fraction of α-synuclein, amelioration of behavioral aberrations and protection from loss of striatal dopaminergic markers. These data indicate that increasing glucocerebrosidase activity can influence α-synuclein homeostasis, thereby reducing the progression of synucleinopathies. This study provides robust in vivo evidence that augmentation of CNS glucocerebrosidase activity is a potential therapeutic strategy for PD, regardless of the mutation status of GBA1.
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Affiliation(s)
- Edward Rockenstein
- Neuroscience Department, University of California San Diego, La Jolla, CA 92093, USA
| | | | | | | | | | - Changyoun Kim
- Neuroscience Department, University of California San Diego, La Jolla, CA 92093, USA
| | - Brian Spencer
- Neuroscience Department, University of California San Diego, La Jolla, CA 92093, USA
| | - Anthony Adame
- Neuroscience Department, University of California San Diego, La Jolla, CA 92093, USA
| | | | | | | | | | - E Masliah
- Neuroscience Department, University of California San Diego, La Jolla, CA 92093, USA.,Pathology Department, University of California San Diego, La Jolla, CA 92093, USA
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146
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Glucocerebrosidase and parkinsonism: lessons to learn. J Neurol 2016; 263:1033-1044. [PMID: 26995357 DOI: 10.1007/s00415-016-8085-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/26/2016] [Accepted: 02/27/2016] [Indexed: 12/23/2022]
Abstract
Both homo- (causing autosomal-recessive Gaucher's disease; GD) and heterozygous mutations in the glucocerebrosidase gene (GBA) are associated with Parkinson's disease (PD), and represent the most robust known genetic susceptibility factors identified in PD. Since the accumulation of α-synuclein has been considered critical to the pathogenesis of PD among several possible pathways through which glucocerebrosidase (GCase) deficiency may promote the pathogenesis of PD, particular attention was given to the reciprocity with α-synuclein levels, lysosomal dysfunction, endoplasmatic reticulum-Golgi trafficking of GCase, dysregulation of calcium homeostasis and mitochondrial abnormalities. The proportion of PD patients that carry GBA mutations is estimated to be approximately between 5 and 10 %. Individual PD patients with or without GBA mutations cannot be discriminated on clinical or pathological grounds. However, GBA mutation carriers may have slightly earlier age at PD onset, more likely have a positive family history for PD, and more prevalent non-motor symptoms when compared to those patients who are not carriers. Establishing the concept of GBA-related PD promoted a search for the pathogenic mechanisms through which GCase deficiency may influence pathogenesis of PD, suggesting that targeting the GCase-lysosomal pathway might be a rational approach for the development of neuroprotective drugs in PD.
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147
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Pal GD, Hall D, Ouyang B, Phelps J, Alcalay R, Pauciulo MW, Nichols WC, Clark L, Mejia-Santana H, Blasucci L, Goetz CG, Comella C, Colcher A, Gan-Or Z, Rouleau GA, Marder K. Genetic and Clinical Predictors of Deep Brain Stimulation in Young-Onset Parkinson's Disease. Mov Disord Clin Pract 2016; 3:465-471. [PMID: 27709117 DOI: 10.1002/mdc3.12309] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE In a cohort of patients with young-onset Parkinson's disease (PD), the authors assessed (1) the prevalence of genetic mutations in those who enrolled in deep brain stimulation (DBS) programs compared with those who did not enroll DBS programs and (2) specific genetic and clinical predictors of DBS enrollment. METHODS Subjects were participants from 3 sites (Columbia University, Rush University, and the University of Pennsylvania) in the Consortium on Risk for Early Onset Parkinson's Disease (CORE-PD) who had an age at onset < 51 years. The analyses presented here focus on glucocerebrosidase (GBA), leucine-rich repeat kinase 2 (LRRK2), and parkin (PRKN) mutation carriers. Mutation carrier status, demographic data, and disease characteristics in individuals who did and did not enroll in DBS were analyzed. The association between mutation status and DBS placement was assessed in logistic regression models. RESULTS Patients who had PD with either GBA, LRRK2, or PRKN mutations were more common in the DBS group (n = 99) compared with the non-DBS group (n = 684; 26.5% vs. 16.8%, respectively; P = 0.02). In a multivariate logistic regression model, GBA mutation status (odds ratio, 2.1; 95% confidence interval, 1.0-4.3; P = 0.05) was associated with DBS surgery enrollment. However, when dyskinesia was included in the multivariate logistic regression model, dyskinesia had a strong association with DBS placement (odds ratio, 3.8; 95% confidence interval, 1.9-7.3; P < 0.0001), whereas the association between GBA mutation status and DBS placement did not persist (P = 0.25). CONCLUSIONS DBS populations are enriched with genetic mutation carriers. The effect of genetic mutation carriers on DBS outcomes warrants further exploration.
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Affiliation(s)
- Gian D Pal
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Deborah Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jessica Phelps
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Roy Alcalay
- Department of Neurology and the Taub Institute, Columbia University Medical Center, New York, NY, USA
| | - Michael W Pauciulo
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - William C Nichols
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lorraine Clark
- Department of Pathology and Cell Biology and the Taub Institute, Columbia University Medical Center, NY, New York, USA
| | - Helen Mejia-Santana
- Department of Neurology and the Taub Institute, Columbia University Medical Center, New York, NY, USA
| | - Lucia Blasucci
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Cynthia Comella
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Amy Colcher
- PRKNson's Disease and Movement Disorders Center, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada; Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Guy A Rouleau
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada; Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; The Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Karen Marder
- Department of Neurology and the Taub Institute, Columbia University Medical Center, New York, NY, USA
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148
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Gan’kina OA, Vasenina EE, Levin OS, Fedotova EY, Illarioshkin SN. Characteristics of Parkinson’s disease course in the heterozygous carriage of mutations in the glucocerebrosidase A gene. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:71-76. [DOI: 10.17116/jnevro20161166271-76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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149
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Goldman JG, Aggarwal NT, Schroeder CD. Mild cognitive impairment: an update in Parkinson's disease and lessons learned from Alzheimer's disease. Neurodegener Dis Manag 2015; 5:425-43. [PMID: 26517759 DOI: 10.2217/nmt.15.34] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Cognitive dysfunction is an important focus of research in Parkinson's disease (PD) and Alzheimer's disease (AD). While the concept of amnestic mild cognitive impairment (MCI) as a prodrome to AD has been recognized for many years, the construct of MCI in PD is a relative newcomer with recent development of diagnostic criteria, biomarker research programs and treatment trials. Controversies and challenges, however, regarding PD-MCI's definition, application, heterogeneity and different trajectories have arisen. This review will highlight current research advances and challenges in PD-MCI. Furthermore, lessons from the AD field, which has witnessed an evolution in MCI/AD definitions, relevant advances in biomarker research and development of disease-modifying and targeted therapeutic trials will be discussed.
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Affiliation(s)
- Jennifer G Goldman
- Rush University Medical Center, Department of Neurological Sciences, Section of Parkinson Disease & Movement Disorders, 1725 W. Harrison Street, Suite 755, Chicago, IL 60612, USA
| | - Neelum T Aggarwal
- Rush University Medical Center, Department of Neurological Sciences & Rush Alzheimer's Disease Center, 600 South Paulina, Suite 1038, Chicago, IL 60612, USA
| | - Cynthia D Schroeder
- Rush University Medical Center, Department of Neurological Sciences, 1735 W. Harrison Street, Suite 306, Chicago, IL 60612, USA
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150
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Gegg ME, Schapira AHV. Mitochondrial dysfunction associated with glucocerebrosidase deficiency. Neurobiol Dis 2015; 90:43-50. [PMID: 26388395 PMCID: PMC4838669 DOI: 10.1016/j.nbd.2015.09.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/08/2015] [Accepted: 09/16/2015] [Indexed: 02/06/2023] Open
Abstract
The lysosomal hydrolase glucocerebrosidase (GCase) is encoded for by the GBA gene. Homozygous GBA mutations cause Gaucher disease (GD), a lysosomal storage disorder. Furthermore, homozygous and heterozygous GBA mutations are numerically the greatest genetic risk factor for developing Parkinson's disease (PD), the second most common neurodegenerative disorder. The loss of GCase activity results in impairment of the autophagy‐lysosome pathway (ALP), which is required for the degradation of macromolecules and damaged organelles. Aberrant protein handling of α-synuclein by the ALP occurs in both GD and PD. α-synuclein is the principle component of Lewy bodies, a defining hallmark of PD. Mitochondrial dysfunction is also observed in both GD and PD. In this review we will describe how mitochondria are affected following loss of GCase activity. The pathogenic mechanisms leading to mitochondria dysfunction will also be discussed, focusing on the likely inhibition of the degradation of mitochondria by the ALP, also termed mitophagy. Other pathogenic cellular processes associated with GBA mutations that might contribute, such as the unfolding of GCase in the endoplasmic reticulum, calcium dysregulation and neuroinflammation will also be described. Impairment of the ALP and mitochondria dysfunction are common pathogenic themes between GD and PD and probably explain why GBA mutations increase the risk of developing PD that is very similar to sporadic forms of the disease.
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Affiliation(s)
- Matthew E Gegg
- Department of Clinical Neuroscience, UCL Institute of Neurology, London NW3 2PF, UK
| | - Anthony H V Schapira
- Department of Clinical Neuroscience, UCL Institute of Neurology, London NW3 2PF, UK.
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