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Rus T, Mlakar J, Ležaić L, Vo A, Nguyen N, Tang C, Fiorini M, Prieto E, Marti-Andres G, Arbizu J, Eidelberg D, Trošt M. Sporadic Creutzfeldt-Jakob disease is associated with reorganization of metabolic connectivity in a pathological brain network. Eur J Neurol 2023; 30:1035-1047. [PMID: 36583625 DOI: 10.1111/ene.15669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Although sporadic Creutzfeldt-Jakob disease (sCJD) is a rare cause of dementia, it is critical to understand its functional networks as the prion protein spread throughout the brain may share similar mechanisms with other more common neurodegenerative disorders. In this study, the metabolic brain network associated with sCJD was investigated and its internal network organization was explored. METHODS We explored 2-[18 F]fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) brain scans of 29 sCJD patients, 56 normal controls (NCs) and 46 other dementia patients from two independent centers. sCJD-related pattern (CJDRP) was identified in a cohort of 16 pathologically proven sCJD patients and 16 age-matched NCs using scaled subprofile modeling/principal component analysis and was prospectively validated in an independent cohort of 13 sCJD patients and 20 NCs. The pattern's specificity was tested on other dementia patients and its clinical relevance by clinical correlations. The pattern's internal organization was further studied using graph theory methods. RESULTS The CJDRP was characterized by relative hypometabolism in the bilateral caudate, thalami, middle and superior frontal gyri, parietal lobe and posterior cingulum in association with relative hypermetabolism in the hippocampi, parahippocampal gyri and cerebellum. The pattern's expression significantly discriminated sCJD from NCs and other dementia patients (p < 0.005; receiver operating characteristic analysis CJD vs. NCs area under the curve [AUC] 0.90-0.96, sCJD vs. Alzheimer's disease AUC 0.78, sCJD vs. behavioral variant of frontotemporal dementia AUC 0.84). The pattern's expression significantly correlated with cognitive, functional decline and disease duration. The metabolic connectivity analysis revealed inefficient information transfer with specific network reorganization. CONCLUSIONS The CJDRP is a robust metabolic biomarker of sCJD. Due to its excellent clinical correlations it has the potential to monitor disease in emerging disease-modifying trials.
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Affiliation(s)
- Tomaž Rus
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Mlakar
- Institute of Pathology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Luka Ležaić
- Department of Nuclear Medicine, University Medical Centre, Ljubljana, Slovenia
| | - An Vo
- Center for Neurosciences, Feinstein Institutes for Medical Research, Manhasset, New York City, USA
| | - Nha Nguyen
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York City, USA
| | - Chris Tang
- Center for Neurosciences, Feinstein Institutes for Medical Research, Manhasset, New York City, USA
| | - Michele Fiorini
- Section of Neuropathology, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Elena Prieto
- Department of Nuclear Medicine and Molecular Imaging, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Gloria Marti-Andres
- Department of Neurology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Javier Arbizu
- Department of Nuclear Medicine and Molecular Imaging, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - David Eidelberg
- Center for Neurosciences, Feinstein Institutes for Medical Research, Manhasset, New York City, USA
| | - Maja Trošt
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Nuclear Medicine, University Medical Centre, Ljubljana, Slovenia
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Lin X, Xu Y, Zhen Z, Xiao K, Chen X, Yang J, Guan H, Shi Q, Dong X, Wang J, Guo Y. Case Report: Genetic Creutzfeldt–Jakob Disease With a G114V Mutation and One Octapeptide Repeat Deletion as a Mimic of Frontotemporal Dementia. Front Neurol 2022; 13:888309. [PMID: 35812092 PMCID: PMC9263511 DOI: 10.3389/fneur.2022.888309] [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: 03/02/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Genetic Creutzfeldt–Jakob disease (gCJD) characterized by mutations in the prion protein (PrP) gene (PRNP) contributes to approximately 10–15% of the overall human prion diseases. Here, we report a rare mutation in the PRNP gene in a Han-Chinese family. A 36-year-old man initiated with anxiety and depression followed by progressive dementia, cogwheel-like rigidity combined with tremors, and he was diagnosed with frontotemporal lobar dementia in the first 2 years. The disease progression was relatively slow, and the patient developed into akinetic mutism in 4 years. To characterize the disease, following the pedigree studies, neuropsychological examination, neuroimaging studies, real-time quaking-induced conversion (RT-QuIC) examination, and so on were conducted. We eventually identified a rare mutation of G114V combined with one octapeptide repeats deletion (1-ORPD) in the PrP in the patient by DNA sequencing. In addition, the same mutation and deletion were subsequently identified in the patient's mother without any syndromes. His maternal grandmother had a late onset of the disease in her 60s. Given that 1-OPRD has never been reported in human prion disease before, our first report that both G114V mutation and 1-OPRD appear in the family would forward our understanding of the etiological mechanisms of the gCJD.
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Affiliation(s)
- Xue Lin
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Puren Hospital, Beijing, China
| | - Yichen Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhen Zhen
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Neurology, People's Hospital of Beijing Daxing District, Beijing, China
| | - Kang Xiao
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xu Chen
- Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jigang Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongzhi Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Shi
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoping Dong
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yanjun Guo
| | - Yanjun Guo
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Jiawei Wang
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Nihat A, Mok TH, Odd H, Thompson AGB, Caine D, McNiven K, O'Donnell V, Tesfamichael S, Rudge P, Collinge J, Mead S. Development of novel clinical examination scales for the measurement of disease severity in Creutzfeldt-Jakob disease. J Neurol Neurosurg Psychiatry 2022; 93:404-412. [PMID: 35022318 PMCID: PMC8921594 DOI: 10.1136/jnnp-2021-327722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To use a robust statistical methodology to develop and validate clinical rating scales quantifying longitudinal motor and cognitive dysfunction in sporadic Creutzfeldt-Jakob disease (sCJD) at the bedside. METHODS Rasch analysis was used to iteratively construct interval scales measuring composite cognitive and motor dysfunction from pooled bedside neurocognitive examinations collected as part of the prospective National Prion Monitoring Cohort study, October 2008-December 2016.A longitudinal clinical examination dataset constructed from 528 patients with sCJD, comprising 1030 Motor Scale and 757 Cognitive Scale scores over 130 patient-years of study, was used to demonstrate scale utility. RESULTS The Rasch-derived Motor Scale consists of 8 items, including assessments reliant on pyramidal, extrapyramidal and cerebellar systems. The Cognitive Scale comprises 6 items, and includes measures of executive function, language, visual perception and memory. Both scales are unidimensional, perform independently of age or gender and have excellent inter-rater reliability. They can be completed in minutes at the bedside, as part of a normal neurocognitive examination. A composite Examination Scale can be derived by averaging both scores. Several scale uses, in measuring longitudinal change, prognosis and phenotypic heterogeneity are illustrated. CONCLUSIONS These two novel sCJD Motor and Cognitive Scales and the composite Examination Scale should prove useful to objectively measure phenotypic and clinical change in future clinical trials and for patient stratification. This statistical approach can help to overcome obstacles to assessing clinical change in rapidly progressive, multisystem conditions with limited longitudinal follow-up.
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Affiliation(s)
- Akin Nihat
- UCL Institute of Prion Diseases, MRC Prion Unit at UCL, London, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Tze How Mok
- UCL Institute of Prion Diseases, MRC Prion Unit at UCL, London, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Hans Odd
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Andrew Geoffrey Bourne Thompson
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Diana Caine
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Kirsty McNiven
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Veronica O'Donnell
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Selam Tesfamichael
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Peter Rudge
- UCL Institute of Prion Diseases, MRC Prion Unit at UCL, London, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - John Collinge
- UCL Institute of Prion Diseases, MRC Prion Unit at UCL, London, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
| | - Simon Mead
- UCL Institute of Prion Diseases, MRC Prion Unit at UCL, London, UK .,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, National Prion Clinic, London, UK
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Younes K, Rojas JC, Wolf A, Sheng‐Yang GM, Paoletti M, Toller G, Caverzasi E, Luisa Mandelli M, Illán‐Gala I, Kramer JH, Cobigo Y, Miller BL, Rosen HJ, Geschwind MD. Selective vulnerability to atrophy in sporadic Creutzfeldt-Jakob disease. Ann Clin Transl Neurol 2021; 8:1183-1199. [PMID: 33949799 PMCID: PMC8164858 DOI: 10.1002/acn3.51290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/16/2020] [Accepted: 12/04/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Identification of brain regions susceptible to quantifiable atrophy in sporadic Creutzfeldt-Jakob disease (sCJD) should allow for improved understanding of disease pathophysiology and development of structural biomarkers that might be useful in future treatment trials. Although brain atrophy is not usually present by visual assessment of MRIs in sCJD, we assessed whether using voxel-based morphometry (VBM) can detect group-wise brain atrophy in sCJD. METHODS 3T brain MRI data were analyzed with VBM in 22 sCJD participants and 26 age-matched controls. Analyses included relationships of regional brain volumes with major clinical variables and dichotomization of the cohort according to expected disease duration based on prion molecular classification (i.e., short-duration/Fast-progressors (MM1, MV1, and VV2) vs. long-duration/Slow-progressors (MV2, VV1, and MM2)). Structural equation modeling (SEM) was used to assess network-level interactions of atrophy between specific brain regions. RESULTS sCJD showed selective atrophy in cortical and subcortical regions overlapping with all but one region of the default mode network (DMN) and the insulae, thalami, and right occipital lobe. SEM showed that the effective connectivity model fit in sCJD but not controls. The presence of visual hallucinations correlated with right fusiform, bilateral thalami, and medial orbitofrontal atrophy. Interestingly, brain atrophy was present in both Fast- and Slow-progressors. Worse cognition was associated with bilateral mesial frontal, insular, temporal pole, thalamus, and cerebellum atrophy. INTERPRETATION Brain atrophy in sCJD preferentially affects specific cortical and subcortical regions, with an effective connectivity model showing strength and directionality between regions. Brain atrophy is present in Fast- and Slow-progressors, correlates with clinical findings, and is a potential biomarker in sCJD.
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Affiliation(s)
- Kyan Younes
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Julio C. Rojas
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Amy Wolf
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Goh M. Sheng‐Yang
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Matteo Paoletti
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
- Advanced Imaging and Radiomics CenterNeuroradiology DepartmentIRCCS Mondino FoundationPaviaItaly
| | - Gianina Toller
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Eduardo Caverzasi
- Department of NeurologyUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Maria Luisa Mandelli
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Ignacio Illán‐Gala
- Department of NeurologyHospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Joel H. Kramer
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Yann Cobigo
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Bruce L. Miller
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Howard J. Rosen
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
| | - Michael D. Geschwind
- Department of NeurologyWeill Institute for NeurosciencesMemory and Aging CenterUniversity of California, San Francisco (UCSF)San FranciscoCalifornia
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Mole J, Mead S, Rudge P, Nihat A, Mok T, Collinge J, Caine D. Cognitive decline heralds onset of symptomatic inherited prion disease. Brain 2021; 144:989-998. [PMID: 33844831 DOI: 10.1093/brain/awaa409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/03/2020] [Accepted: 09/21/2020] [Indexed: 11/14/2022] Open
Abstract
The clinical effectiveness of any disease-modifying treatment for prion disease, as for other neurodegenerative disorders, will depend on early treatment before damage to neural tissue is irrevocable. Thus, there is a need to identify markers that predict disease onset in healthy at-risk individuals. Whilst imaging and neurophysiological biomarkers have shown limited use in this regard, we recently reported progressive neurophysiological changes in individuals with the inherited prion disease mutation P102L. We have also previously demonstrated a signature pattern of fronto-parietal dysfunction in mild prion disease. Here we address whether these cognitive features anticipate the onset of symptoms in a unique sample of patients with inherited prion disease. In the cross-sectional analysis, we analysed the performance of patients at three time points in the course of disease onset: prior to symptoms (n = 27), onset of subjective symptoms without positive clinical findings (n = 8) and symptomatic with positive clinical findings (n = 24). In the longitudinal analysis, we analysed data from 24 patients who were presymptomatic at the time of recruitment and were followed up over a period of up to 17 years, of whom 16 remained healthy and eight converted to become symptomatic. In the cross-sectional analysis, the key finding was that, relative to a group of 25 healthy non-gene carrier controls, patients with subjective symptoms but without positive clinical findings were impaired on a smaller but similar set of tests (Trail Making Test part A, Stroop test, Performance IQ, gesture repetition, figure recall) to those previously found to be impaired in mild prion disease. In the longitudinal analysis, Trail Making Test parts A and B, Stroop test and Performance IQ scores significantly discriminated between patients who remained presymptomatic and those who converted, even before the converters reached criteria for formal diagnosis. Notably, performance on the Stroop test significantly discriminated between presymptomatic patients and converters before the onset of clinical symptoms [area under the curve = 0.83 (95% confidence interval, 0.62-1.00), P = 0.009]. Thus, we report here, for the first time, neuropsychological abnormalities in healthy patients prior to either symptom onset or clinical diagnosis of inherited prion disease. This constitutes an important component of an evolving profile of clinical and biomarker abnormalities in this crucial group for preventive medicine.
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Affiliation(s)
- Joseph Mole
- Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust, London, UK
- Queen Square Institute of Neurology, University College London, London, UK
| | - Simon Mead
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, W1W 7FF, UK
| | - Peter Rudge
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, W1W 7FF, UK
| | - Akin Nihat
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, W1W 7FF, UK
| | - Tzehow Mok
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, W1W 7FF, UK
| | - John Collinge
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, W1W 7FF, UK
| | - Diana Caine
- Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust, London, UK
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
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Sacco S, Paoletti M, Staffaroni AM, Kang H, Rojas J, Marx G, Goh SY, Luisa Mandelli M, Allen IE, Kramer JH, Bastianello S, Henry RG, Rosen H, Caverzasi E, Geschwind MD. Multimodal MRI staging for tracking progression and clinical-imaging correlation in sporadic Creutzfeldt-Jakob disease. Neuroimage Clin 2020; 30:102523. [PMID: 33636540 PMCID: PMC7906895 DOI: 10.1016/j.nicl.2020.102523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/02/2020] [Accepted: 12/01/2020] [Indexed: 12/24/2022]
Abstract
Diffusion imaging is very useful for the diagnosis of sporadic Creutzfeldt-Jakob disease, but it has limitations in tracking disease progression as mean diffusivity changes non-linearly across the disease course. We previously showed that mean diffusivity changes across the disease course follow a quasi J-shaped curve, characterized by decreased values in earlier phases and increasing values later in the disease course. Understanding how MRI metrics change over-time, as well as their correlations with clinical deficits are crucial steps in developing radiological biomarkers for trials. Specifically, as mean diffusivity does not change linearly and atrophy mainly occurs in later stages, neither alone is likely to be a sufficient biomarker throughout the disease course. We therefore developed a model combining mean diffusivity and Volume loss (MRI Disease-Staging) to take into account mean diffusivity's non-linearity. We then assessed the associations between clinical outcomes and mean diffusivity alone, Volume alone and finally MRI Disease-Staging. In 37 sporadic Creutzfeldt-Jakob disease subjects and 30 age- and sex-matched healthy controls, high angular resolution diffusion and high-resolution T1 imaging was performed cross-sectionally to compute z-scores for mean diffusivity (MD) and Volume. Average MD and Volume were extracted from 41 GM volume of interest (VOI) per hemisphere, within the images registered to the Montreal Neurological Institute (MNI) space. Each subject's volume of interest was classified as either "involved" or "not involved" using a statistical threshold of ± 2 standard deviation (SD) for mean diffusivity changes and/or -2 SD for Volume. Volumes of interest were MRI Disease-Staged as: 0 = no abnormalities; 1 = decreased mean diffusivity only; 2 = decreased mean diffusivity and Volume; 3 = normal ("pseudo-normalized") mean diffusivity, reduced Volume; 4 = increased mean diffusivity, reduced Volume. We correlated Volume, MD and MRI Disease-Staging with several clinical outcomes (scales, score and symptoms) using 4 major regions of interest (Total, Cortical, Subcortical and Cerebellar gray matter) or smaller regions pre-specified based on known neuroanatomical correlates. Volume and MD z-scores correlated inversely with each other in all four major ROIs (cortical, subcortical, cerebellar and total) highlighting that ROIs with lower Volumes had higher MD and vice-versa. Regarding correlations with symptoms and scores, higher MD correlated with worse Mini-Mental State Examination and Barthel scores in cortical and cerebellar gray matter, but subjects with cortical sensory deficits showed lower MD in the primary sensory cortex. Volume loss correlated with lower Mini-Mental State Examination, Barthel scores and pyramidal signs. Interestingly, for both Volume and MD, changes within the cerebellar ROI showed strong correlations with both MMSE and Barthel. Supporting using a combination of MD and Volume to track sCJD progression, MRI Disease-Staging showed correlations with more clinical outcomes than Volume or MD alone, specifically with Mini-Mental State Examination, Barthel score, pyramidal signs, higher cortical sensory deficits, as well as executive and visual-spatial deficits. Additionally, when subjects in the cohort were subdivided into tertiles based on their Barthel scores and their percentile of disease duration/course ("Time-Ratio"), subjects in the lowest (most impaired) Barthel tertile showed a much greater proportion of more advanced MRI Disease-Stages than the those in the highest tertile. Similarly, subjects in the last Time-Ratio tertile (last tertile of disease) showed a much greater proportion of more advanced MRI Disease-Stages than the earliest tertile. Therefore, in later disease stages, as measured by time or Barthel, there is overall more Volume loss and increasing MD. A combined multiparametric quantitative MRI Disease-Staging is a useful tool to track sporadic Creutzfeldt-Jakob- disease progression radiologically.
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Affiliation(s)
- Simone Sacco
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), San Francisco, CA, USA
- Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Matteo Paoletti
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Adam M. Staffaroni
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Huicong Kang
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Julio Rojas
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Gabe Marx
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Sheng-yang Goh
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Maria Luisa Mandelli
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Isabel E. Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco San Francisco (UCSF), San Francisco, CA, USA
| | - Joel H. Kramer
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Stefano Bastianello
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Roland G. Henry
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Howie.J. Rosen
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Eduardo Caverzasi
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Michael D. Geschwind
- UCSF Weill Institute for Neurosciences, Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, USA
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7
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Sundaram SE, Staffaroni AM, Walker NC, Casaletto KB, Casey M, Golubjatnikov A, Metcalf S, O’Leary K, Wong K, Benisano K, Forner S, Gonzalez Catalan M, Allen IE, Rosen HJ, Kramer JH, Geschwind MD. Baseline neuropsychological profiles in prion disease predict survival time. Ann Clin Transl Neurol 2020; 7:1535-1545. [PMID: 33314770 PMCID: PMC7480924 DOI: 10.1002/acn3.51115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Few studies have captured the neuropsychological profile of sporadic Creutzfeldt-Jakob disease (sCJD) with neuropsychological testing, and little is known about cognitive predictors of survival. We characterized baseline neuropsychological performance in sCJD and investigated associations with survival. METHODS sCJD participants who completed the MMSE (n = 118), 61 sCJD of whom also completed a neuropsychological battery at baseline, and 135 age-matched healthy controls, were included. Composite scores of global cognition, memory, executive functions, visuospatial, and language were derived. Cox proportional hazard models estimated survival time, controlling for age and education. Additional models adjusted for Barthel Index and PRNP codon 129 polymorphism. RESULTS sCJD participants performed significantly worse than controls on all cognitive tasks and composites with most showing very large effect sizes. The three tests showing the largest group differences were delayed verbal recall (Hedges'g = 4.08, P < 0.0001), Stroop Inhibition (Hedges'g = 3.14, P < 0.0001), and Modified Trails (Hedges'g = 2.94, P < 0.0001). Memory (95%) and executive functioning (87%) composites were most commonly impaired. Poorer global (HR = 0.65, P < 0.0001), visuospatial (HR = 0.82, P < 0.0001), and memory (HR = 0.82, P = 0.01) composites predicted shorter survival. Visuospatial cognition remained a significant predictor even after adjusting for all other cognitive composites; each standard deviation decrease in visuospatial cognition was associated with an 18% higher chance of death (HR = 0.82, P < 0.003). Global (HR = 0.68, P = 0.03) and visuospatial (HR = 0.82, P = 0.001) composites remained significant predictors after controlling for Barthel Index and codon 129. INTERPRETATION sCJD participants exhibit a broad range of cognitive impairments, with memory and executive functioning deficits in the vast majority. Neuropsychological assessment, particularly of visuospatial abilities, informs prognostication in sCJD.
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Affiliation(s)
- Saranya E. Sundaram
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
- Department of PsychologyPalo Alto UniversityPalo AltoCalifornia
| | - Adam M. Staffaroni
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Nicole C. Walker
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
- Department of PsychologyCalifornia School of Professional PsychologyAlliant International UniversitySan FranciscoCalifornia
| | - Kaitlin B. Casaletto
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Megan Casey
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Aili Golubjatnikov
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Stacy Metcalf
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Kelly O’Leary
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Katherine Wong
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Kendra Benisano
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Sven Forner
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Marta Gonzalez Catalan
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
- Department of PsychologyPalo Alto UniversityPalo AltoCalifornia
| | - Isabel E. Allen
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCalifornia
| | - Howard J. Rosen
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Michael D. Geschwind
- Department of Neurology, Memory and Aging CenterWeill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCalifornia
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8
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Giovagnoli AR, Tallarita G, Parente A, Del Sole A, Di Fede G. A new neurobehavioral phenotype of familial Creutzfeldt-Jakob disease: impaired theory of mind. Neurol Sci 2018; 40:1073-1075. [PMID: 30483993 DOI: 10.1007/s10072-018-3646-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/12/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Rita Giovagnoli
- Department of Diagnostics and Applied Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Giulia Tallarita
- Department of Diagnostics and Applied Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Annalisa Parente
- Department of Diagnostics and Applied Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Angelo Del Sole
- Nuclear Medicine Unit, ASST Santi Paolo e Carlo and Department of Health Sciences, University of Milan, Milan, Italy
| | - Giuseppe Di Fede
- Department of Diagnostics and Applied Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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9
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Abstract
Arguably the most important goal of prion research is the discovery of a safe and effective treatment for the human diseases. The final stages of the pathway to develop a treatment require clinical trials. Choices about how a trial is designed and conducted have a large impact on the chances of success. The gold-standard large randomized double-blind placebo-controlled study, which minimizes sources of bias and has been incredibly successful in other diseases, has been hard to achieve in Creutzfeldt-Jakob disease principally because of the rarity and rapidity of the clinical syndrome. To date, clinical trials have been restricted to repurposed compounds, doxycycline, quinacrine, pentosan polysulfate (PPS), and flupertine. In most cases, these trials have used survival as an endpoint, which, whilst clearcut, has limitations. Biomarkers have played a strong role in diagnosis and entry criteria, but only a limited role as secondary outcome measures. Recent developments suggest some possible improvements in trial design by use of new outcome measures that have more favorable properties, and biomarkers of neuronal damage and/or prion seeding activity. Alternative patient populations, including those at risk of genetic forms of prion disease, warrant more consideration. In the future, improved trial designs will be employed to test compounds designed specifically to treat prion diseases.
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Affiliation(s)
- Simon Mead
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, and MRC Prion Unit at University College London Institute of Prion Diseases, London, United Kingdom.
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10
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Saraceno L, Ricigliano VAG, Cavalli M, Cagol A, Bosco G, Moda F, Caroppo P, Meola G. Sporadic MM-1 Type Creutzfeldt-Jakob Disease With Hemiballic Presentation and No Cognitive Impairment Until Death: How New NCJDRSU Diagnostic Criteria May Allow Early Diagnosis. Front Neurol 2018; 9:739. [PMID: 30233486 PMCID: PMC6134320 DOI: 10.3389/fneur.2018.00739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/14/2018] [Indexed: 12/05/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease is the most common human prion disorder. Although associated with heterogeneous clinical phenotypes, its distinctive feature is the presence of a rapidly progressive multidomain cognitive impairment. We describe the atypical case of a patient affected by sporadic Methionine/Methionine type 1 Creutzfeldt-Jakob disease (typically associated with early cognitive decline) who presented with an isolated hemiballic syndrome and no signs of cognitive involvement until death. We review sporadic Creutzfeldt-Jakob disease diagnostic criteria and their updates since their first formulation, highlighting their limitations in clinical diagnostic work-up. Finally, we discuss the recently introduced National Creutzfeldt-Jakob Disease Research and Surveillance Unit diagnostic criteria, suggesting how their application could support an early clinical diagnosis, even in atypical cases, such as the one presented.
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Affiliation(s)
- Lorenzo Saraceno
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Vito A G Ricigliano
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Michele Cavalli
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Alessandro Cagol
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Giovanna Bosco
- Department of Neurology, IRCCS Policlinico San Donato, Milan, Italy
| | - Fabio Moda
- Carlo Besta Neurological Institute, IRCCS Foundation, Milan, Italy
| | - Paola Caroppo
- Carlo Besta Neurological Institute, IRCCS Foundation, Milan, Italy
| | - Giovanni Meola
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy.,Department of Neurology, IRCCS Policlinico San Donato, Milan, Italy
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11
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Devitt G, Howard K, Mudher A, Mahajan S. Raman Spectroscopy: An Emerging Tool in Neurodegenerative Disease Research and Diagnosis. ACS Chem Neurosci 2018; 9:404-420. [PMID: 29308873 DOI: 10.1021/acschemneuro.7b00413] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The pathogenesis underlining many neurodegenerative diseases remains incompletely understood. The lack of effective biomarkers and disease preventative medicine demands the development of new techniques to efficiently probe the mechanisms of disease and to detect early biomarkers predictive of disease onset. Raman spectroscopy is an established technique that allows the label-free fingerprinting and imaging of molecules based on their chemical constitution and structure. While analysis of isolated biological molecules has been widespread in the chemical community, applications of Raman spectroscopy to study clinically relevant biological species, disease pathogenesis, and diagnosis have been rapidly increasing since the past decade. The growing number of biomedical applications has shown the potential of Raman spectroscopy for detection of novel biomarkers that could enable the rapid and accurate screening of disease susceptibility and onset. Here we provide an overview of Raman spectroscopy and related techniques and their application to neurodegenerative diseases. We further discuss their potential utility in research, biomarker detection, and diagnosis. Challenges to routine use of Raman spectroscopy in the context of neuroscience research are also presented.
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12
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Leighton PLA, Allison WT. Protein Misfolding in Prion and Prion-Like Diseases: Reconsidering a Required Role for Protein Loss-of-Function. J Alzheimers Dis 2018; 54:3-29. [PMID: 27392869 DOI: 10.3233/jad-160361] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Prion disease research has contributed much toward understanding other neurodegenerative diseases, including recent demonstrations that Alzheimer's disease (AD) and other neurodegenerative diseases are prion-like. Prion-like diseases involve the spread of degeneration between individuals and/or among cells or tissues via template directed misfolding, wherein misfolded protein conformers propagate disease by causing normal proteins to misfold. Here we use the premise that AD, amyotrophic lateral sclerosis, Huntington's disease, and other similar diseases are prion-like and ask: Can we apply knowledge gained from studies of these prion-like diseases to resolve debates about classical prion diseases? We focus on controversies about what role(s) protein loss-of-function might have in prion diseases because this has therapeutic implications, including for AD. We examine which loss-of-function events are recognizable in prion-like diseases by considering the normal functions of the proteins before their misfolding and aggregation. We then delineate scenarios wherein gain-of-function and/or loss-of-function would be necessary or sufficient for neurodegeneration. We consider roles of PrPC loss-of-function in prion diseases and in AD, and conclude that the conventional wisdom that prion diseases are 'toxic gain-of-function diseases' has limitations. While prion diseases certainly have required gain-of-function components, we propose that disease phenotypes are predominantly caused by deficits in the normal physiology of PrPC and its interaction partners as PrPC converts to PrPSc. In this model, gain-of-function serves mainly to spread disease, and loss-of-function directly mediates neuron dysfunction. We propose experiments and predictions to assess our conclusion. Further study on the normal physiological roles of these key proteins is warranted.
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Affiliation(s)
- Patricia L A Leighton
- Centre for Prions & Protein Folding Disease, University of Alberta, Edmonton, AB, Canada.,Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada
| | - W Ted Allison
- Centre for Prions & Protein Folding Disease, University of Alberta, Edmonton, AB, Canada.,Department of Biological Sciences, University of Alberta, Edmonton, AB, Canada.,Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
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13
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Leighton PLA, Nadolski NJ, Morrill A, Hamilton TJ, Allison WT. An ancient conserved role for prion protein in learning and memory. Biol Open 2018; 7:bio.025734. [PMID: 29358166 PMCID: PMC5829491 DOI: 10.1242/bio.025734] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The misfolding of cellular prion protein (PrPC) to form PrP Scrapie (PrPSc) is an exemplar of toxic gain-of-function mechanisms inducing propagated protein misfolding and progressive devastating neurodegeneration. Despite this, PrPC function in the brain is also reduced and subverted during prion disease progression; thus understanding the normal function of PrPC in healthy brains is key. Disrupting PrPC in mice has led to a myriad of controversial functions that sometimes map onto disease symptoms, including a proposed role in memory or learning. Intriguingly, PrPC interaction with amyloid beta (Aβ) oligomers at synapses has also linked its function to Alzheimer's disease and dementia in recent years. We set out to test the involvement of PrPC in memory using a disparate animal model, the zebrafish. Here we document an age-dependent memory decline in prp2−/− zebrafish, pointing to a conserved and ancient role of PrPC in memory. Specifically, we found that aged (3-year-old) prp2−/− fish performed poorly in an object recognition task relative to age-matched prp2+/+ fish or 1-year-old prp2−/− fish. Further, using a novel object approach (NOA) test, we found that aged (3-year-old) prp2−/− fish approached the novel object more than either age-matched prp2+/+ fish or 1-year-old prp2−/− fish, but did not have decreased anxiety when we tested them in a novel tank diving test. Taken together, the results of the NOA and novel tank diving tests suggest an altered cognitive appraisal of the novel object in the 3-year-old prp2−/− fish. The learning paradigm established here enables a path forward to study PrPC interactions of relevance to Alzheimer's disease and prion diseases, and to screen for candidate therapeutics for these diseases. The findings underpin a need to consider the relative contributions of loss- versus gain-of-function of PrPC during Alzheimer's and prion diseases, and have implications upon the prospects of several promising therapeutic strategies. Summary: Prion protein dysfunction at the synapse impacts learning in Alzheimer disease. Here, we demonstrate similar roles for prion protein in zebrafish, revealing ancient constructive roles for this infamously toxic protein.
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Affiliation(s)
- Patricia L A Leighton
- Centre for Prions and Protein Folding Disease, University of Alberta, Edmonton, AB T6G 2M8, Canada.,Department of Biological Sciences, University of Alberta, Edmonton, AB T6G 2E9, Canada
| | - Nathan J Nadolski
- Department of Psychology, MacEwan University, Edmonton, AB T5J 4S2, Canada
| | - Adam Morrill
- Department of Psychology, MacEwan University, Edmonton, AB T5J 4S2, Canada
| | - Trevor J Hamilton
- Department of Psychology, MacEwan University, Edmonton, AB T5J 4S2, Canada .,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2E1
| | - W Ted Allison
- Centre for Prions and Protein Folding Disease, University of Alberta, Edmonton, AB T6G 2M8, Canada .,Department of Biological Sciences, University of Alberta, Edmonton, AB T6G 2E9, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2E1.,Department of Medical Genetics, University of Alberta, Edmonton, AB T6G 2H7, Canada
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14
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Caine D, Nihat A, Crabb P, Rudge P, Cipolotti L, Collinge J, Mead S. The language disorder of prion disease is characteristic of a dynamic aphasia and is rarely an isolated clinical feature. PLoS One 2018; 13:e0190818. [PMID: 29304167 PMCID: PMC5755885 DOI: 10.1371/journal.pone.0190818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/20/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Akinetic mutism is a key diagnostic feature of prion diseases, however, their rapidly progressive nature makes detailed investigation of the language disorder in a large cohort extremely challenging. This study aims to position prion diseases in the nosology of language disorders and improve early clinical recognition. METHODS A systematic, prospective investigation of language disorders in a large cohort of patients diagnosed with prion diseases. 568 patients were included as a sub-study of the National Prion Monitoring Cohort. All patients had at least one assessment with the MRC Scale, a milestone-based functional scale with language and non-language components. Forty patients, with early symptoms and able to travel to the study site, were also administered a comprehensive battery of language tests (spontaneous speech, semantics, syntax, repetition, naming, comprehension and lexical retrieval under different conditions). RESULTS 5/568 (0.9%) patients presented with leading language symptoms. Those with repeated measurements deteriorated at a slower rate in language compared to non-language milestones. Amongst the subgroup of 40 patients who underwent detailed language testing, only three tasks-semantic and phonemic fluency and sentence comprehension-were particularly vulnerable early in the disease. These tasks were highly correlated with performance on non-verbal executive tests. Patients were also impaired on a test of dynamic aphasia. CONCLUSION These results provide evidence that the language disorder in prion disease is rarely an isolated clinical or cognitive feature. The language abnormality is indicative of a dynamic aphasia in the context of a prominent dysexecutive syndrome, similar to that seen in patients with the degenerative movement disorder progressive supranuclear palsy (PSP).
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Affiliation(s)
- Diana Caine
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, United Kingdom
| | - Akin Nihat
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, United Kingdom
| | - Philippa Crabb
- Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Peter Rudge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, United Kingdom
| | - Lisa Cipolotti
- Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - John Collinge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, United Kingdom
| | - Simon Mead
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, United Kingdom
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15
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Allison WT, DuVal MG, Nguyen-Phuoc K, Leighton PLA. Reduced Abundance and Subverted Functions of Proteins in Prion-Like Diseases: Gained Functions Fascinate but Lost Functions Affect Aetiology. Int J Mol Sci 2017; 18:E2223. [PMID: 29064456 PMCID: PMC5666902 DOI: 10.3390/ijms18102223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 12/12/2022] Open
Abstract
Prions have served as pathfinders that reveal many aspects of proteostasis in neurons. The recent realization that several prominent neurodegenerative diseases spread via a prion-like mechanism illuminates new possibilities for diagnostics and therapeutics. Thus, key proteins in Alzheimer Disease and Amyotrophic lateral sclerosis (ALS), including amyloid-β precursor protein, Tau and superoxide dismutase 1 (SOD1), spread to adjacent cells in their misfolded aggregated forms and exhibit template-directed misfolding to induce further misfolding, disruptions to proteostasis and toxicity. Here we invert this comparison to ask what these prion-like diseases can teach us about the broad prion disease class, especially regarding the loss of these key proteins' function(s) as they misfold and aggregate. We also consider whether functional amyloids might reveal a role for subverted protein function in neurodegenerative disease. Our synthesis identifies SOD1 as an exemplar of protein functions being lost during prion-like protein misfolding, because SOD1 is inherently unstable and loses function in its misfolded disease-associated form. This has under-appreciated parallels amongst the canonical prion diseases, wherein the normally folded prion protein, PrPC, is reduced in abundance in fatal familial insomnia patients and during the preclinical phase in animal models, apparently via proteostatic mechanisms. Thus while template-directed misfolding and infectious properties represent gain-of-function that fascinates proteostasis researchers and defines (is required for) the prion(-like) diseases, loss and subversion of the functions attributed to hallmark proteins in neurodegenerative disease needs to be integrated into design towards effective therapeutics. We propose experiments to uniquely test these ideas.
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Affiliation(s)
- W Ted Allison
- Centre for Prions & Protein Folding Disease, University of Alberta, Edmonton, AB T6G 2M8, Canada.
- Department of Biological Sciences, University of Alberta, Edmonton, AB T6G 2E9, Canada.
- Department of Medical Genetics, University of Alberta, Edmonton, AB T6G 2M8, Canada.
| | - Michèle G DuVal
- Department of Biological Sciences, University of Alberta, Edmonton, AB T6G 2E9, Canada.
| | - Kim Nguyen-Phuoc
- Centre for Prions & Protein Folding Disease, University of Alberta, Edmonton, AB T6G 2M8, Canada.
- Department of Medical Genetics, University of Alberta, Edmonton, AB T6G 2M8, Canada.
| | - Patricia L A Leighton
- Centre for Prions & Protein Folding Disease, University of Alberta, Edmonton, AB T6G 2M8, Canada.
- Department of Biological Sciences, University of Alberta, Edmonton, AB T6G 2E9, Canada.
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16
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Crutch SJ, Schott JM, Rabinovici GD, Murray M, Snowden JS, van der Flier WM, Dickerson BC, Vandenberghe R, Ahmed S, Bak TH, Boeve BF, Butler C, Cappa SF, Ceccaldi M, de Souza LC, Dubois B, Felician O, Galasko D, Graff-Radford J, Graff-Radford NR, Hof PR, Krolak-Salmon P, Lehmann M, Magnin E, Mendez MF, Nestor PJ, Onyike CU, Pelak VS, Pijnenburg Y, Primativo S, Rossor MN, Ryan NS, Scheltens P, Shakespeare TJ, Suárez González A, Tang-Wai DF, Yong KXX, Carrillo M, Fox NC. Consensus classification of posterior cortical atrophy. Alzheimers Dement 2017; 13:870-884. [PMID: 28259709 PMCID: PMC5788455 DOI: 10.1016/j.jalz.2017.01.014] [Citation(s) in RCA: 377] [Impact Index Per Article: 53.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 01/06/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION A classification framework for posterior cortical atrophy (PCA) is proposed to improve the uniformity of definition of the syndrome in a variety of research settings. METHODS Consensus statements about PCA were developed through a detailed literature review, the formation of an international multidisciplinary working party which convened on four occasions, and a Web-based quantitative survey regarding symptom frequency and the conceptualization of PCA. RESULTS A three-level classification framework for PCA is described comprising both syndrome- and disease-level descriptions. Classification level 1 (PCA) defines the core clinical, cognitive, and neuroimaging features and exclusion criteria of the clinico-radiological syndrome. Classification level 2 (PCA-pure, PCA-plus) establishes whether, in addition to the core PCA syndrome, the core features of any other neurodegenerative syndromes are present. Classification level 3 (PCA attributable to AD [PCA-AD], Lewy body disease [PCA-LBD], corticobasal degeneration [PCA-CBD], prion disease [PCA-prion]) provides a more formal determination of the underlying cause of the PCA syndrome, based on available pathophysiological biomarker evidence. The issue of additional syndrome-level descriptors is discussed in relation to the challenges of defining stages of syndrome severity and characterizing phenotypic heterogeneity within the PCA spectrum. DISCUSSION There was strong agreement regarding the definition of the core clinico-radiological syndrome, meaning that the current consensus statement should be regarded as a refinement, development, and extension of previous single-center PCA criteria rather than any wholesale alteration or redescription of the syndrome. The framework and terminology may facilitate the interpretation of research data across studies, be applicable across a broad range of research scenarios (e.g., behavioral interventions, pharmacological trials), and provide a foundation for future collaborative work.
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Affiliation(s)
| | | | - Gil D Rabinovici
- Department of Neurology, Memory & Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Melissa Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Julie S Snowden
- Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK; Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Wiesje M van der Flier
- Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands; Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Samrah Ahmed
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas H Bak
- Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Christopher Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Stefano F Cappa
- Center for Cognitive Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Mathieu Ceccaldi
- INSERM U 1106, Institut des Neurosciences des Systèmes, Aix Marseille Université, Marseilles, France
| | - Leonardo Cruz de Souza
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruno Dubois
- Institute for Memory and Alzheimer's Disease, UMR-S975, Salpêtrière Hospital, Pierre & Marie Curie University, Paris, France
| | - Olivier Felician
- Aix-Marseille Université, INSERM, Institut de Neurosciences des Systèmes, Marseille, France; AP-HM Hôpitaux de la Timone, Service de Neurologie et Neuropsychologie, Marseille, France
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, San Diego, USA
| | | | | | - Patrick R Hof
- Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Pierre Krolak-Salmon
- Clinical and Research Memory Center of Lyon, Hospices Civils de Lyon, INSERM U1028, CNRS UMR5292, University of Lyon, Lyon, France
| | - Manja Lehmann
- Dementia Research Centre, UCL Institute of Neurology, London, UK; Department of Neurology, Memory & Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Eloi Magnin
- Department of Neurology, Regional Memory Centre (CMRR), CHU Besançon, Besançon, France
| | - Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peter J Nestor
- Cognitive Neurology and Neurodegeneration Group, German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Victoria S Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yolande Pijnenburg
- Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands; Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Silvia Primativo
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Martin N Rossor
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Natalie S Ryan
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Philip Scheltens
- Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands; Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Aida Suárez González
- Dementia Research Centre, UCL Institute of Neurology, London, UK; Memory Disorders Unit, Neurology Department, University Hospital Virgen del Rocio, Seville, Spain
| | - David F Tang-Wai
- Division of Neurology, University Health Network Memory Clinic, University of Toronto, Toronto, Ontario, Canada
| | - Keir X X Yong
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Maria Carrillo
- Medical and Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Nick C Fox
- Dementia Research Centre, UCL Institute of Neurology, London, UK
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17
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Ehler E, Pipka M, Meleková A, Mandysová P, Johanidesová S, Matěj R, Rusina R. The Heidenhain variant of Creutzfeldt-Jakob disease and concomitant tau pathology: A case report. Neurol Neurochir Pol 2017; 51:197-200. [PMID: 28236445 DOI: 10.1016/j.pjnns.2017.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/19/2017] [Indexed: 11/19/2022]
Abstract
The Heidenhain form of Creutzfeldt-Jakob disease (CJD) is a rare CJD variant with predominantly visual symptoms in the early stages. Clinical manifestations of metamorphopsia, hemianopia and Balint's syndrome correlate with the involvement of the posterior cortical regions. A 71-year old healthy and very active man was admitted because of impaired visual acuity, hemianopia, and gait disturbance progressing over one week. MRI found typical cortical hyperintensities in the occipital regions while rhythm slowing and sharp waves were seen in the occipital regions on EEG. Protein 14-3-3 was detected in the cerebrospinal fluid. Postmortem neuropathology revealed typical histopathological changes consistent with CJD. Moreover, we found deposits of phosphorylated tau protein in the limbic regions that met the criteria for primary age-related tauopathy (PART); representing an additional and interesting finding in our case.
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Affiliation(s)
- Edvard Ehler
- Department of Neurology, Regional Hospital Pardubice, Czech Republic
| | - Michael Pipka
- Department of Neurology, Regional Hospital Pardubice, Czech Republic
| | - Alena Meleková
- Department of Neurology, Regional Hospital Pardubice, Czech Republic
| | - Petra Mandysová
- Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic; Department of Neurology, Regional Hospital Pardubice, Czech Republic
| | - Silvie Johanidesová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and the General University Hospital, Prague, Czech Republic
| | - Radoslav Matěj
- Department of Pathology and Molecular Medicine, Thomayer Hospital, Prague, Czech Republic; Department of Pathology, First Faculty of Medicine, Charles University in Prague and the General University Hospital, Prague, Czech Republic
| | - Robert Rusina
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and the General University Hospital, Prague, Czech Republic; Department of Neurology, Thomayer Hospital, Prague, Czech Republic
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18
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Abstract
Rapidly progressive dementia mimicking Creutzfeldt–Jakob disease (CJD) is a relatively rare presentation but a rewarding one to become familiar with, as the potential diagnoses range from the universally fatal to the completely reversible. Patients require urgent decisions about assessment and investigation and have quickly evolving needs for treatments and support, through symptom management and end-of-life care in most cases. We have based this pragmatic review on the experiences of a specialist prion referral centre in the UK, which, unsurprisingly, is strongly biased towards seeing patients with CJD. Cases eventually proven not to have prion disease might be described as ‘CJD-mimics’; being referred from UK neurologists, these are the most challenging cases. CJD in its classical presentation is very rarely mimicked; however, it is highly heterogeneous, and atypical forms can mimic virtually all common neurodegenerative syndromes. Warning features of a mimic include generalised seizures, hyponatraemia, fever, a facial movement disorder, a normal neurological examination and a modestly rapid presentation. Contrast-enhancing lesions or MRI signal hyperintensity outside the striatum, thalamus or cortex and a cerebrospinal fluid pleocytosis are key investigation pointers to a CJD mimic.
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Affiliation(s)
- Simon Mead
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Peter Rudge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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19
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González DA, Soble JR. Corticobasal syndrome due to sporadic Creutzfeldt–Jakob disease: a review and neuropsychological case report. Clin Neuropsychol 2016; 31:676-689. [DOI: 10.1080/13854046.2016.1259434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- David Andrés González
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Jason R. Soble
- Psychology Service, South Texas Veterans Health Care System, San Antonio, TX
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20
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Peggion C, Bertoli A, Sorgato MC. Almost a century of prion protein(s): From pathology to physiology, and back to pathology. Biochem Biophys Res Commun 2016; 483:1148-1155. [PMID: 27581199 DOI: 10.1016/j.bbrc.2016.07.118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 07/27/2016] [Indexed: 12/30/2022]
Abstract
Prions are one of the few pathogens whose name is renowned at all population levels, after the dramatic years pervaded by the fear of eating prion-infected food. If now this, somehow irrational, scare of bovine meat inexorably transmitting devastating brain disorders is largely subdued, several prion-related issues are still unsolved, precluding the design of therapeutic approaches that could slow, if not halt, prion diseases. One unsolved issue is, for example, the role of the prion protein (PrPC), whole conformational misfolding originates the prion but whose physiologic reason d'etre in neurons, and in cells at large, remains enigmatic. Preceded by a historical outline, the present review will discuss the functional pleiotropicity ascribed to PrPC, and whether this aspect could fall, at least in part, into a more concise framework. It will also be devoted to radically different perspectives for PrPC, which have been recently brought to the attention of the scientific world with unexpected force. Finally, it will discuss the possible reasons allowing an evolutionary conserved and benign protein, as PrPC is, to turn into a high affinity receptor for pathologic misfolded oligomers, and to transmit their toxic message into neurons.
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Affiliation(s)
- Caterina Peggion
- Department of Biomedical Sciences, University of Padova, Via Bassi 58/B, 35131 Padova, Italy.
| | - Alessandro Bertoli
- Department of Biomedical Sciences, University of Padova, Via Bassi 58/B, 35131 Padova, Italy
| | - M Catia Sorgato
- Department of Biomedical Sciences, University of Padova, Via Bassi 58/B, 35131 Padova, Italy; C.N.R. Institute of Neuroscience, University of Padova, Via Bassi 58/B, 35131 Padova, Italy.
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