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Gharaylou Z, Shafaghi L, Pestehei SK, Hadjighassem M. Long-term bumetanide administration altered behavioral pattern in mosaic Down's Syndrome: A case report. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:88-95. [PMID: 34860628 DOI: 10.1080/21622965.2021.2007481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The behavioral phenotypes emerge from cognitive architecture comprising attention, executive functions, and primary communication skills that all have shown remarkable deficits in Down's Syndrome (DS). These states arise from the proper functional interactions of the contributing neurotransmission and neuromodulation systems and other coding platforms. Gamma-aminobutyric acid (GABA) is an integral part of the neural interaction and regulation networks that its reverse action leads to broad detrimental consequences. This inhibitory substance needs an appropriate balance of co-transporters that largely shape the ionic milieu. Bumetanide, a specific NKCC1 inhibitor used for an eighteen-month interval, showed promising effects in restoring some behavior deficits in a fourteen-year-old boy diagnosed with genetically confirmed mosaic Down's Syndrome.
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Affiliation(s)
- Zeinab Gharaylou
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Shefa Neuroscience Research Center, Tehran, Iran
| | - Lida Shafaghi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahmoudreza Hadjighassem
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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2
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Lamsal Lamichhane S, Ramesh V, Opara CO, Khan FY, Kabiraj G, Kauser H, Palakeel JJ, Ali M, Chaduvula P, Chhabra S, Mohammed L. Treatment Modalities for Dementia in Down’s Syndrome: A Literature Review. Cureus 2022; 14:e27881. [PMID: 36110433 PMCID: PMC9462651 DOI: 10.7759/cureus.27881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
Down's syndrome (DS) is the most well-known chromosomal abnormality characterized by an extra chromosome 21 and multiple systemic issues. The higher production of amyloid precursor protein (APP), the precursor peptide of beta-amyloid, predisposes persons with DS to early Alzheimer's disease (AD). The prevalence of dementia has increased as a function of the extended life expectancy of persons with DS. Because we know little about the treatment of dementia in persons with DS, this review focuses on the pathophysiology and management strategies to improve the overall quality of life.
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Feng B, Hoskins W, Zhang Y, Meng Z, Samuels DC, Wang J, Xia R, Liu C, Tang J, Guo Y. Bi-stream CNN Down Syndrome screening model based on genotyping array. BMC Med Genomics 2018; 11:105. [PMID: 30453947 PMCID: PMC6245487 DOI: 10.1186/s12920-018-0416-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Human Down syndrome (DS) is usually caused by genomic micro-duplications and dosage imbalances of human chromosome 21. It is associated with many genomic and phenotype abnormalities. Even though human DS occurs about 1 per 1,000 births worldwide, which is a very high rate, researchers haven't found any effective method to cure DS. Currently, the most efficient ways of human DS prevention are screening and early detection. METHODS In this study, we used deep learning techniques and analyzed a set of Illumina genotyping array data. We built a bi-stream convolutional neural networks model to screen/predict the occurrence of DS. Firstly, we built image input data by converting the intensities of each SNP site into chromosome SNP maps. Next, we proposed a bi-stream convolutional neural network (CNN) architecture with nine layers and two branch models. We further merged two CNN branch models into one model in the fourth convolutional layer, and output the prediction in the last layer. RESULTS Our bi-stream CNN model achieved 99.3% average accuracies, and very low false-positive and false-negative rates, which was necessary for further applications in disease prediction and medical practice. We further visualized the feature maps and learned filters from intermediate convolutional layers, which showed the genomic patterns and correlated SNPs variations in human DS genomes. We also compared our methods with other CNN and traditional machine learning models. We further analyzed and discussed the characteristics and strengths of our bi-stream CNN model. CONCLUSIONS Our bi-stream model used two branch CNN models to learn the local genome features and regional patterns among adjacent genes and SNP sites from two chromosomes simultaneously. It achieved the best performance in all evaluating metrics when compared with two single-stream CNN models and three traditional machine-learning algorithms. The visualized feature maps also provided opportunities to study the genomic markers and pathway components associated with Human DS, which provided insights for gene therapy and genomic medicine developments.
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Affiliation(s)
- Bing Feng
- College of Education, Zhejiang University, Hangzhou, Zhejiang, 310058, People's Republic of China.,Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA
| | - William Hoskins
- Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA
| | - Yan Zhang
- Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA.,School of Computer Science and Technology, Tianjin University, 300072, Tianjin, 300072, People's Republic of China
| | - Zibo Meng
- Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA
| | - David C Samuels
- Vanderbilt University School of Medicine,Vanderbilt University, Nashville, 37232, TN, USA
| | - Jiandong Wang
- Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA
| | - Ruofan Xia
- Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA
| | - Chao Liu
- College of Education, Zhejiang University, Hangzhou, Zhejiang, 310058, People's Republic of China
| | - Jijun Tang
- College of Education, Zhejiang University, Hangzhou, Zhejiang, 310058, People's Republic of China. .,Department of Computer Science and Engineering,University of South Carolina, Columbia, 29208, SC, USA. .,School of Computer Science and Technology, Tianjin University, 300072, Tianjin, 300072, People's Republic of China.
| | - Yan Guo
- School of Medicine,The University of New Mexico, Albuquerque, 87131, NM, USA.
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Rafii MS, Skotko BG, McDonough ME, Pulsifer M, Evans C, Doran E, Muranevici G, Kesslak P, Abushakra S, Lott IT. A Randomized, Double-Blind, Placebo-Controlled, Phase II Study of Oral ELND005 (scyllo-Inositol) in Young Adults with Down Syndrome without Dementia. J Alzheimers Dis 2018; 58:401-411. [PMID: 28453471 DOI: 10.3233/jad-160965] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND ELND005 (scyllo-Inositol; cyclohexane-1,2,3,4,5,6-hexol) has been evaluated as a potential disease-modifying treatment for Alzheimer's disease (AD). Individuals with Down syndrome (DS) have an increased risk for developing AD dementia. OBJECTIVE To evaluate the safety and tolerability of ELND005 and to determine its pharmacokinetics (PK) and relationship between PK parameters, safety outcome measures, and exploratory efficacy outcome measures in young adults with DS without dementia. METHODS This was a prospective, randomized, double-blind, placebo-controlled, parallel-group, three-arm, multicenter Phase II study of the safety and pharmacokinetics of ELND005 administered orally for 4 weeks (ClinicalTrials.gov NCT01791725). Participants who met study eligibility criteria were randomly assigned in a 2 : 1:1 ratio to receive ELND005 at either 250 mg twice daily (BID) or 250 mg once daily (QD) or matching placebo for 4 weeks. RESULTS There were no apparent treatment group-related trends on cognitive or behavioral measures and there were no SAEs and no deaths in the study. Overall, mean changes from baseline in clinical laboratory parameters, vital sign measurements, electrocardiogram results, and other physical findings were unremarkable. ELND005 accumulation averaged approximately 2-fold with QD dosing, and 3- to 4-fold with BID dosing. CONCLUSION Overall, treatment of adults with DS with ELND005 at both doses was well tolerated, achieved measurable blood levels and demonstrated no safety findings. Further studies will be needed to test efficacy.
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Affiliation(s)
- Michael S Rafii
- Alzheimer's Therapeutic Research Institute (ATRI) at University of Southern California, San Diego, CA, USA.,Department of Neurosciences, University of California, San Diego, CA, USA
| | - Brian G Skotko
- Department of Pediatrics, Down Syndrome Program, Division of Medical Genetics, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Mary Ellen McDonough
- Department of Pediatrics, Down Syndrome Program, Division of Medical Genetics, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret Pulsifer
- Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Psychology Assessment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Casey Evans
- Department of Psychiatry, Psychology Assessment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Eric Doran
- Department of Pediatrics, University of California, Irvine, CA, USA
| | | | | | | | - Ira T Lott
- Department of Pediatrics, University of California, Irvine, CA, USA
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5
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Prasher VP, Mahmood H, Mitra M. Challenges faced in managing dementia in Alzheimer's disease in patients with Down syndrome. Degener Neurol Neuromuscul Dis 2016; 6:85-94. [PMID: 30050371 PMCID: PMC6053091 DOI: 10.2147/dnnd.s91754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Dementia in Alzheimer’s disease (DAD) is more common in adults with Down syndrome (DS), with characteristically an earlier onset. The treatment of DAD is not too dissimilar in the general population and in people with intellectual disabilities. However, the underlying intellectual disability can make the management of DAD more challenging in older adults with DS. This literature review aimed to look at the management of DAD in people with DS. The management of dementia is holistic. This includes treating reversible factors, aiming to slow the cognitive decline, psychological therapies, ensuring that the environment is appropriate, and use of psychotropic medication when necessary to manage behavioral problems, psychotic symptoms, depressive symptoms, and sleep difficulty. Antidementia medications have a role to play but remain limited. The management of DAD in the DS population can be at times challenging, but good clinical practice should involve accurate diagnosis of dementia, treating any reversible additional factors, consideration of psychological and behavioral management, use of antidementia medication, and a multidisciplinary team approach.
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Affiliation(s)
- Vee P Prasher
- Birmingham Learning Disability Service, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK,
| | - Hassan Mahmood
- Birmingham Learning Disability Service, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK,
| | - Madhumanti Mitra
- Birmingham Learning Disability Service, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK,
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6
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Livingstone N, Hanratty J, McShane R, Macdonald G. Pharmacological interventions for cognitive decline in people with Down syndrome. Cochrane Database Syst Rev 2015; 2015:CD011546. [PMID: 26513128 PMCID: PMC8763347 DOI: 10.1002/14651858.cd011546.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND People with Down syndrome are vulnerable to developing dementia at an earlier age than the general population. Alzheimer's disease and cognitive decline in people with Down syndrome can place a significant burden on both the person with Down syndrome and their family and carers. Various pharmacological interventions, including donepezil, galantamine, memantine and rivastigmine, appear to have some effect in treating cognitive decline in people without Down syndrome, but their effectiveness for those with Down syndrome remains unclear. OBJECTIVES To assess the effectiveness of anti-dementia pharmacological interventions and nutritional supplements for treating cognitive decline in people with Down syndrome. SEARCH METHODS In January 2015, we searched CENTRAL, ALOIS (the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group), Ovid MEDLINE, Embase, PsycINFO, seven other databases, and two trials registers. In addition, we checked the references of relevant reviews and studies and contacted study authors, other researchers and relevant drug manufacturers to identify additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of anti-dementia pharmacological interventions or nutritional supplements for adults (aged 18 years and older) with Down syndrome, in which treatment was administered and compared with either placebo or no treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias of included trials and extracted the relevant data. Review authors contacted study authors to obtain missing information where necessary. MAIN RESULTS Only nine studies (427 participants) met the inclusion criteria for this review. Four of these (192 participants) assessed the effectiveness of donepezil, two (139 participants) assessed memantine, one (21 participants) assessed simvastatin, one study (35 participants) assessed antioxidants, and one study (40 participants) assessed acetyl-L-carnitine.Five studies focused on adults aged 45 to 55 years, while the remaining four studies focused on adults aged 20 to 29 years. Seven studies were conducted in either the USA or UK, one between Norway and the UK, and one in Japan. Follow-up periods in studies ranged from four weeks to two years. The reviewers judged all included studies to be at low or unclear risk of bias.Analyses indicate that for participants who received donepezil, scores in measures of cognitive functioning (standardised mean difference (SMD) 0.52, 95% confidence interval (CI) -0.27 to 1.13) and measures of behaviour (SMD 0.42, 95% CI -0.06 to 0.89) were similar to those who received placebo. However, participants who received donepezil were significantly more likely to experience an adverse event (odds ratio (OR) 0.32, 95% CI 0.16 to 0.62). The quality of this body of evidence was low. None of the included donepezil studies reported data for carer stress, institutional/home care, or death.For participants who received memantine, scores in measures of cognitive functioning (SMD 0.05, 95% CI -0.43 to 0.52), behaviour (SMD -0.17, 95% CI -0.46 to 0.11), and occurrence of adverse events (OR 0.45, 95% CI 0.18 to 1.17) were similar to those who received placebo. The quality of this body of evidence was low. None of the included memantine studies reported data for carer stress, institutional/home care, or death.Due to insufficient data, it was possible to provide a narrative account only of the outcomes for simvastatin, antioxidants, and acetyl-L-carnitine. Results from one pilot study suggest that participants who received simvastatin may have shown a slight improvement in cognitive measures. AUTHORS' CONCLUSIONS Due to the low quality of the body of evidence in this review, it is difficult to draw conclusions about the effectiveness of any pharmacological intervention for cognitive decline in people with Down syndrome.
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Affiliation(s)
- Nuala Livingstone
- Queen's University BelfastSchool of Sociology, Social Policy and Social Work6 College ParkBelfastUKBT7 1LP
| | - Jennifer Hanratty
- Queen's University BelfastSchool of Sociology, Social Policy and Social Work6 College ParkBelfastUKBT7 1LP
| | - Rupert McShane
- University of OxfordRadcliffe Department of MedicineJohn Radcliffe HospitalLevel 4, Main Hospital, Room 4401COxfordOxfordshireUKOX3 9DU
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7
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Pekrul SR, Fitzgerald KD. Memantine Augmentation in a Down's Syndrome Adolescent with Treatment- Resistant Obsessive-Compulsive Disorder. J Child Adolesc Psychopharmacol 2015; 25:593-5. [PMID: 26258664 DOI: 10.1089/cap.2015.0073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Scott R Pekrul
- Department of Child and Adolescent Psychiatry, University of Michigan Ann Arbor, Michigan
| | - Kate D Fitzgerald
- Department of Child and Adolescent Psychiatry, University of Michigan Ann Arbor, Michigan
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8
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Robertson J, Hatton C, Baines S, Emerson E. Systematic Reviews of the Health or Health care of People with Intellectual Disabilities: A Systematic Review to Identify Gaps in the Evidence Base. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2015; 28:455-523. [DOI: 10.1111/jar.12149] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Janet Robertson
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
| | - Chris Hatton
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
| | - Susannah Baines
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
| | - Eric Emerson
- Centre for Disability Research; Division of Health Research; Lancaster University; Lancaster UK
- Centre for Disability Research and Policy; University of Sydney; Sydney NSW Australia
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9
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Carfì A, Antocicco M, Brandi V, Cipriani C, Fiore F, Mascia D, Settanni S, Vetrano DL, Bernabei R, Onder G. Characteristics of adults with down syndrome: prevalence of age-related conditions. Front Med (Lausanne) 2014; 1:51. [PMID: 25593924 PMCID: PMC4292207 DOI: 10.3389/fmed.2014.00051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 11/20/2014] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In the last decades, life expectancy of persons with Down syndrome (DS) has dramatically increased and it is estimated that they will be living as long as the general population within a generation. Despite being included among the progeroid syndromes, because of the presence of features typically observed in older adults, DS is still regarded as a disease of pediatric interest. Because limited knowledge is available on the clinical characteristics of adults with DS, this study aimed to assess clinical and non-clinical features of this population and to describe similarities to the geriatric population. METHODS In this study, we described 60 adults with DS evaluated at the Day Hospital of the Geriatric Department of the Policlinico A. Gemelli, Università Cattolica del Sacro Cuore in Rome. Individuals were assessed through a standardized protocol. RESULTS The mean age of study participants was 38 years (range, 18-58 years) and 42 (70.0%) were women. Geriatric conditions were highly prevalent: severe cognitive impairment was diagnosed in 39 (65.0%) participants, behavioral symptoms were present in 25 (41.7%), and functional impairment in 23 (38.3%). Six (10.0%) participants lived in institutions and 11 (18.3%) were diagnosed as obese. The mean number of drugs used was 2.4; use of psychotropic drugs was highly prevalent. The most common chronic diseases were thyroid problems (44, 73.3%), followed by mood disorders (19, 31.7%), osteoporosis (18, 30.0%), and cardiac problems (10, 16.7%). Geriatric conditions and chronic diseases were more prevalent among participants aged ≥40 years. CONCLUSION Several similarities between older adults and adults with DS were observed. Comorbidities, geriatric conditions, cognitive and functional deficits, and social problems are highly prevalent in both populations, contributing to the high complexity of these patients' assessment and treatment.
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Affiliation(s)
- Angelo Carfì
- Department of Geriatrics, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Manuela Antocicco
- Department of Geriatrics, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Brandi
- Department of Geriatrics, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Camilla Cipriani
- Department of Geriatrics, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Fiore
- Department of Geriatrics, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Donatella Mascia
- Department of Geriatrics, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvana Settanni
- Department of Geriatrics, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide L. Vetrano
- Department of Geriatrics, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
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Kelley CM, Powers BE, Velazquez R, Ash JA, Ginsberg SD, Strupp BJ, Mufson EJ. Maternal choline supplementation differentially alters the basal forebrain cholinergic system of young-adult Ts65Dn and disomic mice. J Comp Neurol 2014; 522:1390-410. [PMID: 24178831 PMCID: PMC3959592 DOI: 10.1002/cne.23492] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/10/2013] [Accepted: 10/15/2013] [Indexed: 12/29/2022]
Abstract
Down syndrome (DS), trisomy 21, is a multifaceted condition marked by intellectual disability and early presentation of Alzheimer's disease (AD) neuropathological lesions including degeneration of the basal forebrain cholinergic neuron (BFCN) system. Although DS is diagnosable during gestation, there is no treatment option for expectant mothers or DS individuals. Using the Ts65Dn mouse model of DS that displays age-related degeneration of the BFCN system, we investigated the effects of maternal choline supplementation on the BFCN system in adult Ts65Dn mice and disomic (2N) littermates at 4.3-7.5 months of age. Ts65Dn dams were maintained on a choline-supplemented diet (5.1 g/kg choline chloride) or a control, unsupplemented diet with adequate amounts of choline (1 g/kg choline chloride) from conception until weaning of offspring; post weaning, offspring were fed the control diet. Mice were transcardially perfused with paraformaldehyde, and brains were sectioned and immunolabeled for choline acetyltransferase (ChAT) or p75-neurotrophin receptor (p75(NTR) ). BFCN number and size, the area of the regions, and the intensity of hippocampal labeling were determined. Ts65Dn-unsupplemented mice displayed region- and immunolabel-dependent increased BFCN number, larger areas, smaller BFCNs, and overall increased hippocampal ChAT intensity compared with 2N unsupplemented mice. These effects were partially normalized by maternal choline supplementation. Taken together, the results suggest a developmental imbalance in the Ts65Dn BFCN system. Early maternal-diet choline supplementation attenuates some of the genotype-dependent alterations in the BFCN system, suggesting this naturally occurring nutrient as a treatment option for pregnant mothers with knowledge that their offspring is trisomy 21.
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Affiliation(s)
- Christy M. Kelley
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
| | - Brian E. Powers
- Div. Nutritional Sciences and Dept. of Psychology, Cornell University, Ithaca, NY 14853, USA
| | - Ramon Velazquez
- Div. Nutritional Sciences and Dept. of Psychology, Cornell University, Ithaca, NY 14853, USA
| | - Jessica A. Ash
- Div. Nutritional Sciences and Dept. of Psychology, Cornell University, Ithaca, NY 14853, USA
| | - Stephen D. Ginsberg
- Center for Dementia Research, Nathan Kline Institute, Orangeburg, NY, USA, and Depts. of Psychiatry, and Physiology & Neuroscience, New York University Langone Medical Center, New York, NY 10962, USA
| | - Barbara J. Strupp
- Div. Nutritional Sciences and Dept. of Psychology, Cornell University, Ithaca, NY 14853, USA
| | - Elliott J. Mufson
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
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Bello O, Blair K, Chapleau C, Larimore JL. Is memantine a potential therapeutic for Rett syndrome? Front Neurosci 2013; 7:245. [PMID: 24381538 PMCID: PMC3865366 DOI: 10.3389/fnins.2013.00245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 11/29/2013] [Indexed: 11/13/2022] Open
Abstract
Memantine is a low-affinity, voltage-dependent, non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist. It is classified as a neuroprotective aminoadamantane. It does not cure or reverse Alzheimer's but it does effectively treat symptoms, slows the progression of the disease and allows many patients to perform daily cognitive activities with clear thoughts. Based on it's success in patients with Alzheimer's, memantine has been tested in other neurological disorders with impaired learning and memory. In this review, we will discuss the success and failures of memantine in Downs Syndrome and Fragile X research and from those results, assess the potential benefit of memantine in Rett Syndrome (RTT).
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Affiliation(s)
- Olivia Bello
- Department of Biology, Agnes Scott College Decatur, GA, USA
| | - Kelsey Blair
- Department of Pharmacy, University of Alabama at Birmingham Birmingham, AL, USA
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12
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Aging and down syndrome. Curr Gerontol Geriatr Res 2012; 2012:412536. [PMID: 22844278 PMCID: PMC3400297 DOI: 10.1155/2012/412536] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 05/15/2012] [Indexed: 12/29/2022] Open
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Abstract
This chapter reviews the neurological phenotype of Down syndrome (DS) in early development, childhood, and aging. Neuroanatomic abnormalities in DS are manifested as aberrations in gross brain structure as well as characteristic microdysgenetic changes. As the result of these morphological abnormalities, brain circuitry is impaired. While an intellectual disability is ubiquitous in DS, there is a wide range of variation in cognitive performance and a growing understanding between aberrant brain circuitry and the cognitive phenotype. Hypotonia is most marked at birth, affecting gait and ligamentous laxity. Seizures are bimodal in presentation with infantile spasms common in infancy and generalized seizures associated with cognitive decline observed in later years. While all individuals have the characteristic neuropathology of Alzheimer's disease (AD) by age 40 years, the prevalence of dementia is not universal. The tendency to develop AD is related, in part, to several genes on chromosome 21 that are overexpressed in DS. Intraneuronal accumulation of β-amyloid appears to trigger a cascade of neurodegeneration resulting in the neuropathological and clinical manifestations of dementia. Functional brain imaging has elucidated the temporal sequence of amyloid deposition and glucose metabolic rate in the development of dementia in DS. Mitochondrial abnormalities contribute to oxidative stress which is part of AD pathogenesis in DS as well as AD in the general population. A variety of medical comorbidities threaten cognitive performance including sleep apnea, abnormalities in thyroid metabolism, and behavioral disturbances. Mouse models for DS are providing a platform for the formulation of clinical trials with intervention targeted to synaptic plasticity, brain biochemistry, and morphological brain alterations.
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Affiliation(s)
- Ira T Lott
- Department of Pediatrics and Neurology, School of Medicine, University of California Irvine (UCI), Orange, CA, USA.
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Ruparelia A, Wiseman F, Sheppard O, Tybulewicz VL, Fisher EM. Down syndrome and the molecular pathogenesis resulting from trisomy of human chromosome 21. J Biomed Res 2010; 24:87-99. [PMID: 23554618 PMCID: PMC3596542 DOI: 10.1016/s1674-8301(10)60016-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Indexed: 01/12/2023] Open
Abstract
Chromosome copy number aberrations, anueploidies, are common in the human population but generally lethal. However, trisomy of human chromosome 21 is compatible with life and people born with this form of aneuploidy manifest the features of Down syndrome, named after Langdon Down who was a 19(th) century British physician who first described a group of people with this disorder. Down syndrome includes learning and memory deficits in all cases, as well as many other features which vary in penetrance and expressivity in different people. While Down syndrome clearly has a genetic cause - the extra dose of genes on chromosome 21 - we do not know which genes are important for which aspects of the syndrome, which biochemical pathways are disrupted, or, generally how design therapies to ameliorate the effects of these disruptions. Recently, with new insights gained from studying mouse models of Down syndrome, specific genes and pathways are being shown to be involved in the pathogenesis of the disorder. This is opening the way for exciting new studies of potential therapeutics for aspects of Down syndrome, particularly the learning and memory deficits.
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Affiliation(s)
- Aarti Ruparelia
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
| | - Frances Wiseman
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
| | - Olivia Sheppard
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
| | | | - Elizabeth M.C. Fisher
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
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Communication breaks-Down: from neurodevelopment defects to cognitive disabilities in Down syndrome. Prog Neurobiol 2010; 91:1-22. [PMID: 20097253 DOI: 10.1016/j.pneurobio.2010.01.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 12/10/2009] [Accepted: 01/14/2010] [Indexed: 12/31/2022]
Abstract
Down syndrome (DS) is the leading cause of genetically-defined intellectual disability and congenital birth defects. Despite being one of the first genetic diseases identified, only recently, thanks to the phenotypic analysis of DS mouse genetic models, we have begun to understand how trisomy may impact cognitive function. Cognitive disabilities in DS appear to result mainly from two pathological processes: neurogenesis impairment and Alzheimer-like degeneration. In DS brain, suboptimal network architecture and altered synaptic communication arising from neurodevelopmental impairment are key determinants of cognitive defects. Hypocellularity and hypoplasia start at early developmental stages and likely depend upon impaired proliferation of neuronal precursors, resulting in reduction of numbers of neurons and synaptic contacts. The impairment of neuronal precursor proliferation extends to adult neurogenesis and may affect learning and memory. Neurodegenerative mechanisms also contribute to DS cognitive impairment. Early onset Alzheimer disease occurs with extremely high incidence in DS patients and is causally-related to overexpression of beta-amyloid precursor protein (betaAPP), which is one of the triplicated genes in DS. In this review, we will survey the available findings on neurodevelopmental and neurodegenerative changes occurring in DS throughout life. Moreover, we will discuss the potential mechanisms by which defects in neurogenesis and neurodegenerative processes lead to altered formation of neural circuits and impair cognitive function, in connection with findings on pharmacological treatments of potential benefit for DS.
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Abstract
BACKGROUND Alzheimer's dementia (AD) is the most common form of dementia in people with Down Syndrome (DS). Acetylcholine is a chemical found in the brain that has an important role in memory, attention, reason and language. Galantamine both inhibits the activity of acetylcholinesterase and increases the level of acetylcholine. Galantamine can improve cognitive function and slow the decline of AD in the general population over time. It is important to note that people with DS tend to present with AD at a much younger age than the normal population as well as having subtle differences in physiology (e.g. metabolism and heart rate) and may therefore have different requirements from the general population. OBJECTIVES To determine the effectiveness and safety of galantamine for people with DS who develop AD. SEARCH STRATEGY CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, BIOSIS, SCI, SSCI and the NRR were searched up to October 2008. We contacted the manufacturers of galantamine as well as experts in the field, to ask about reports of unpublished or ongoing trials. SELECTION CRITERIA Randomised controlled trials of participants with DS and AD in which treatment with galantamine was administered compared with a placebo group. DATA COLLECTION AND ANALYSIS No study was identified which met inclusion criteria for this review. MAIN RESULTS No study was identified which met inclusion criteria for this review. AUTHORS' CONCLUSIONS As there are no included trials, recommendations cannot be made about galantamine for AD in DS. Well-designed, adequately powered studies are required.
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Affiliation(s)
- Monica Mohan
- Department of Neuropsychiatry, Neuropsychology and Epileptology, Burden Centre, North Bristol Trust, Frenchay Hospital, Bristol, Avon, UK, BS16 1JB.
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17
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Abstract
BACKGROUND Alzheimer's dementia (AD) is the most common form of dementia in people with Down Syndrome [DS]. Acetylcholine is a chemical found in the brain that has an important role in memory, attention, reason and language. Donepezil a reversible inhibitor of acetylcholinesterase, which is thought to maintain levels of acetylcholine, and is reported to have some benefits for people with AD in the general population. It is important to note that people with DS tend to present with AD at a much younger age than the normal population as well as having subtle differences in physiology (e.g. metabolism and heart rate) and may therefore have different requirements from the general population. OBJECTIVES To determine the effectiveness and safety of donepezil for people with DS who develop AD. SEARCH STRATEGY CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, BIOSIS, SCI, SSCI and the NRR were searched up to October 2008. We contacted the manufacturers of donepezil as well as experts in the field, to ask about reports of unpublished or ongoing trials. SELECTION CRITERIA Randomised controlled trials of participants with DS and AD in which treatment with donepezil was administered compared with a placebo group. DATA COLLECTION AND ANALYSIS Data were extracted from the published reports of the one relevant study identified. MAIN RESULTS The one study included in this review is a small (n=30) randomised controlled trial lasting 24 weeks. It was followed-up by an open label study with a crossover design.No significant differences were found on any four validated outcomes including global functioning and three measures of cognitive abilities and behavioural problems. 6 out of 16 carers (37%) of participants on donepezil and 2 out of 15 (13%) on placebo reported improvement. No data were available for day to day skills, institutionalisation, reduction in carers' stress or economic outcomes. Half the intervention group and 20% of the placebo group reported adverse events; two participants left because of adverse events. AUTHORS' CONCLUSIONS To date there is only one small randomised controlled study on the effect of donepezil. This shows, at best, a modest, non statistically significant trend in favour of people with Down syndrome and Alzheimer's dementia who are able to tolerate donepezil (this drug is currently only dispensed in relatively large doses and is contraindicated for those with cardiac and respiratory problems).This study does not provide good evidence on which to base practice. Findings in an open-label follow up to this study suggest possible benefit in some individuals. Further, larger randomised controlled studies with longer-term follow up are required.
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Affiliation(s)
- Monica Mohan
- Department of Neuropsychiatry, Neuropsychology and Epileptology, Burden Centre, North Bristol Trust, Frenchay Hospital, Bristol, Avon, UK, BS16 1JB.
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