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Torres V, Pérez-Montesino J, Fernández-Santiago R, Fernández M, Camara A, Compta Y, Martí MJ, Guerra Beltran À, Rios J, Valldeoriola F, Ezquerra M. DRD4 gene polymorphism and impulse control disorder induced by dopamine agonists in Parkinson's disease. Ann Clin Transl Neurol 2024. [PMID: 38952083 DOI: 10.1002/acn3.52111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/09/2024] [Accepted: 05/15/2024] [Indexed: 07/03/2024] Open
Abstract
Impulse control disorders and their consequences display variability among individuals, indicating potential involvement of environmental and genetic factors. In this retrospective study, we analyzed a cohort of Parkinson's disease patients treated with dopamine agonists and investigated the influence of the dopamine D4 receptor gene polymorphism, DRD4 7R+, which is linked to psychiatric disorders, impulsive traits, and addictive behaviors. We found that DRD4 7R+ is a significant genetic risk factor associated with the severity of ICD.
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Affiliation(s)
- Viviana Torres
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies UBNeuro, Hospital Clínic Universitari de Barcelona, Barcelona, Catalonia, Spain
| | - Jesica Pérez-Montesino
- Lab of Parkinson's disease and other Neurodegenerative Movement Disorders: Clinical and Experimental Research, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, 08036, Catalonia, Spain
| | - Rubén Fernández-Santiago
- Lab of Parkinson's disease and other Neurodegenerative Movement Disorders: Clinical and Experimental Research, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, 08036, Catalonia, Spain
| | - Manel Fernández
- Lab of Parkinson's disease and other Neurodegenerative Movement Disorders: Clinical and Experimental Research, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, 08036, Catalonia, Spain
| | - Ana Camara
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies UBNeuro, Hospital Clínic Universitari de Barcelona, Barcelona, Catalonia, Spain
| | - Yaroslau Compta
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies UBNeuro, Hospital Clínic Universitari de Barcelona, Barcelona, Catalonia, Spain
| | - María-José Martí
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies UBNeuro, Hospital Clínic Universitari de Barcelona, Barcelona, Catalonia, Spain
| | - Àlex Guerra Beltran
- Lab of Parkinson's disease and other Neurodegenerative Movement Disorders: Clinical and Experimental Research, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, 08036, Catalonia, Spain
| | - José Rios
- Department of Clinical Pharmacology, Hospital Clinic, and Medical Statistics Core Facility, Institutd'InvestigacionsBiomèdiques August Pi ISunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Biostatistics Unit, School of Medicine, UniversitatAutònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Francesc Valldeoriola
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies UBNeuro, Hospital Clínic Universitari de Barcelona, Barcelona, Catalonia, Spain
| | - Mario Ezquerra
- Lab of Parkinson's disease and other Neurodegenerative Movement Disorders: Clinical and Experimental Research, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, 08036, Catalonia, Spain
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Carbone F, Djamshidian A. Impulse Control Disorders in Parkinson's Disease: An Overview of Risk Factors, Pathogenesis and Pharmacological Management. CNS Drugs 2024; 38:443-457. [PMID: 38613665 PMCID: PMC11098885 DOI: 10.1007/s40263-024-01087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/15/2024]
Abstract
Impulse control disorders in Parkinson's disease are relatively common drug-induced addictive behaviours that are usually triggered by the dopamine agonists pramipexole, ropinirole and rotigotine. This narrative review aimed to provide a comprehensive overview of the current knowledge of impulse control disorders in Parkinson's disease. We summarised the prevalence, clinical features, risk factors and potential underlying mechanisms of impulse control disorders in Parkinson's disease. Moreover, recent advances in behavioural and imaging characteristics and management strategies are discussed. Early detection as well as a tailored multidisciplinary approach, which typically includes careful adjustment of the dopaminergic therapy and the treatment of associated neuropsychiatric symptoms, are necessary. In some cases, a continuous delivery of levodopa via a pump or the dopamine D1 receptor agonist, apomorphine, can be considered. In selected patients without cognitive or speech impairment, deep brain stimulation of the subthalamic nucleus can also improve addictions. Finding the right balance of tapering dopaminergic dose (usually dopamine agonists) without worsening motor symptoms is essential for a beneficial long-term outcome.
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Affiliation(s)
- Federico Carbone
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
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Morrow CB, Hinkle JT, Seemiller J, Mills KA, Pontone GM. The Association of Antidepressant Use and Impulse Control Disorder in Parkinson's Disease. Am J Geriatr Psychiatry 2024; 32:710-720. [PMID: 38238235 PMCID: PMC11096064 DOI: 10.1016/j.jagp.2023.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVES To examine whether initiation of an antidepressant is associated with the development of impulse control disorder (ICD) in patients with Parkinson's disease (PD). DESIGN We performed a retrospective analysis utilizing data from the Parkinson's Progression Markers Initiative (PPMI). Two-sample Mann-Whitney tests were used for comparison of continuous variables and Pearson χ2 tests were used for categorical variables. Kaplan-Meier survival analysis and cox proportional hazards regression analysis was used to assess the hazard of ICD with antidepressant exposure. SETTING The PPMI is a multicenter observational study of early PD with 52 sites throughout North America, Europe, and Africa. PARTICIPANTS Participants in the current study were those in the PPMI PD cohort with a primary diagnosis of idiopathic PD. MEASUREMENTS The presence of ICD was captured using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP). Antidepressant use was defined based on medication logs for each participant. Depressive symptoms were captured using the Geriatric Depression Scale (GDS). RESULTS A total of 1,045 individuals were included in the final analysis. There was a significant increase in the probability of ICD in those exposed to serotonergic antidepressants compared to those not exposed (Log-rank p <0.001). Serotonergic antidepressant use was associated with a hazard ratio for ICD of 1.4 (95% CI 1.0-1.8, z-value 2.1, p = 0.04) after adjusting for dopamine agonist use, depression, bupropion use, MAOI-B use, amantadine use, LEDD, disease duration, sex, and age. CONCLUSIONS Serotonergic antidepressant use appears to be temporally associated with ICD in patients with PD.
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Affiliation(s)
- Christopher B Morrow
- Department of Psychiatry and Behavioral Sciences (CBM, JTH, GMP), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Jared T Hinkle
- Department of Psychiatry and Behavioral Sciences (CBM, JTH, GMP), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph Seemiller
- Department of Neurology (JS, KAM), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kelly A Mills
- Department of Neurology (JS, KAM), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences (CBM, JTH, GMP), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (GMP), University of Florida College of Medicine, Gainesville, FL
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Marras C, Fereshtehnejad SM, Berg D, Bohnen NI, Dujardin K, Erro R, Espay AJ, Halliday G, Van Hilten JJ, Hu MT, Jeon B, Klein C, Leentjens AFG, Mollenhauer B, Postuma RB, Rodríguez-Violante M, Simuni T, Weintraub D, Lawton M, Mestre TA. Transitioning from Subtyping to Precision Medicine in Parkinson's Disease: A Purpose-Driven Approach. Mov Disord 2024; 39:462-471. [PMID: 38243775 DOI: 10.1002/mds.29708] [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: 09/21/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Abstract
The International Parkinson and Movement Disorder Society (MDS) created a task force (TF) to provide a critical overview of the Parkinson's disease (PD) subtyping field and develop a guidance on future research in PD subtypes. Based on a literature review, we previously concluded that PD subtyping requires an ultimate alignment with principles of precision medicine, and consequently novel approaches were needed to describe heterogeneity at the individual patient level. In this manuscript, we present a novel purpose-driven framework for subtype research as a guidance to clinicians and researchers when proposing to develop, evaluate, or use PD subtypes. Using a formal consensus methodology, we determined that the key purposes of PD subtyping are: (1) to predict disease progression, for both the development of therapies (use in clinical trials) and prognosis counseling, (2) to predict response to treatments, and (3) to identify therapeutic targets for disease modification. For each purpose, we describe the desired product and the research required for its development. Given the current state of knowledge and data resources, we see purpose-driven subtyping as a pragmatic and necessary step on the way to precision medicine. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Connie Marras
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Nicolaas I Bohnen
- Departments of Radiology & Neurology, University of Michigan, University of Michigan Udall Center, Ann Arbor, Michigan, USA
| | - Kathy Dujardin
- Center of Excellence for Parkinson's Disease, CHU Lille, Univ Lille, Inserm, Lille Neuroscience & Cognition, Lille, France
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Neuroscience Section, University of Salerno, Baronissi, Italy
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Glenda Halliday
- Brain and Mind Centre and Faculty of Medicine and Health School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Jacobus J Van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, Oxford University and John Radcliffe Hospital, West Wing, Neurology Department, Level 3, Oxford, United Kingdom
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Christine Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Department of Neurology, University Medical Center Goettingen, Kassel, Germany
| | - Ronald B Postuma
- Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | | | - Tanya Simuni
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania; Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Michael Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tiago A Mestre
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, The University of Ottawa Brain and Research Institute, Ottawa, Ontario, Canada
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Heldmann M, Rinckens C, Brüggemann N, Al-Khaled M, Münte TF. Creative thinking and cognitive estimation in Parkinson's disease. Neurol Res Pract 2024; 6:9. [PMID: 38355739 PMCID: PMC10868033 DOI: 10.1186/s42466-023-00304-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/16/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PD) have been reported to exhibit unusual bouts of creativity (e.g., painting, writing), in particular in the context of treatment with dopaminergic agents. Here we investigated divergent and convergent thinking thought to underlie creativity. In addition we assessed cognitive estimation. METHOD Twenty PD patients and 20 matched healthy control participants were subjected to the Guilford Alternate Uses task (divergent thinking), the remote associates task (convergent thinking) and two tests of cognitive estimation. RESULTS No group differences were found for the convergent thinking task, while the Guilford Alternate Uses task revealed a decreased number of correct responses and a reduced originality for PD patients. Originality in PD was correlated to total daily dose of dopaminergic medication. Moreover, both tasks of cognitive estimation showed an impairment in PD. CONCLUSION Only minor effects were found for psychometric indices of subprocesses of creative thinking, while estimation, relying on executive functioning, is impaired in PD. We suggest to take a product oriented view of creativity in further research on altered creative processes in PD.
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Affiliation(s)
- Marcus Heldmann
- Department of Neurology, University of Lübeck, Lübeck, Germany
- Center for Brain, Behavior and Metabolism, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Celia Rinckens
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Department of Neurology, University of Lübeck, Lübeck, Germany
- Center for Brain, Behavior and Metabolism, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | | | - Thomas F Münte
- Center for Brain, Behavior and Metabolism, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Debove I, Paschen S, Amstutz D, Cardoso F, Corvol JC, Fung VSC, Lang AE, Martinez Martin P, Rodríguez-Oroz MC, Weintraub D, Krack P, Deuschl G. Management of Impulse Control and Related Disorders in Parkinson's Disease: An Expert Consensus. Mov Disord 2024; 39:235-248. [PMID: 38234035 DOI: 10.1002/mds.29700] [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: 08/08/2023] [Revised: 10/23/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Impulse-control and related behavioral disorders (ICBDs) significantly impact the lives of Parkinson's disease (PD) patients and caregivers, with lasting consequences if undiagnosed and untreated. While ICBD pathophysiology and risk factors are well-studied, a standardized severity definition and treatment evidence remain elusive. OBJECTIVE This work aimed to establish international expert consensus on ICBD treatment strategies. To comprehensively address diverse treatment availabilities, experts from various continents were included. METHODS From 2021 to 2023, global movement disorders specialists engaged in a Delphi process. A core expert group initiated surveys, involving a larger panel in three iterations, leading to refined severity definitions and treatment pathways. RESULTS Experts achieved consensus on defining ICBD severity, emphasizing regular PD patient screenings for early detection. General treatment recommendations focused on continuous monitoring, collaboration with significant others, and seeking specialist advice for legal or financial challenges. For mild to severe ICBDs, gradual reduction in dopamine agonists was endorsed, followed by reductions in other PD medications. Second-line treatment strategies included diverse approaches like reversing the last medication change, cognitive behavior therapy, subthalamic nucleus deep brain stimulation, and specific medications like quetiapine, clozapine, and antidepressants. The panel reached consensus on distinct treatment pathways for punding and dopamine dysregulation syndrome, formulating therapy recommendations. Comprehensive discussions addressed management strategies for the exacerbation of either motor or non-motor symptoms following the proposed treatments. CONCLUSION The consensus offers in-depth insights into ICBD management, presenting clear severity criteria and expert consensus treatment recommendations. The study highlights the critical need for further research to enhance ICBD management. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ines Debove
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Steffen Paschen
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Deborah Amstutz
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Francisco Cardoso
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, The Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jean-Christophe Corvol
- Department of Neurology, Sorbonne Université, Paris Brain Institute (ICM), Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony E Lang
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Pablo Martinez Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | | | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Paul Krack
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
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Lim SY, Klein C. Parkinson's Disease is Predominantly a Genetic Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:467-482. [PMID: 38552119 DOI: 10.3233/jpd-230376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The discovery of a pathogenic variant in the alpha-synuclein (SNCA) gene in the Contursi kindred in 1997 indisputably confirmed a genetic cause in a subset of Parkinson's disease (PD) patients. Currently, pathogenic variants in one of the seven established PD genes or the strongest known risk factor gene, GBA1, are identified in ∼15% of PD patients unselected for age at onset and family history. In this Debate article, we highlight multiple avenues of research that suggest an important - and in some cases even predominant - role for genetics in PD aetiology, including familial clustering, high rates of monogenic PD in selected populations, and complete penetrance with certain forms. At first sight, the steep increase in PD prevalence exceeding that of other neurodegenerative diseases may argue against a predominant genetic etiology. Notably, the principal genetic contribution in PD is conferred by pathogenic variants in LRRK2 and GBA1 and, in both cases, characterized by an overall late age of onset and age-related penetrance. In addition, polygenic risk plays a considerable role in PD. However, it is likely that, in the majority of PD patients, a complex interplay of aging, genetic, environmental, and epigenetic factors leads to disease development.
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Affiliation(s)
- Shen-Yang Lim
- The Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, Division of Neurology, University of Malaya, Kuala Lumpur, Malaysia
| | - Christine Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
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Laurencin C, Timestit N, Marques A, Duchez DD, Giordana C, Meoni S, Huddlestone M, Danaila T, Anheim M, Klinger H, Vidal T, Fatisson M, Caire C, Nourredine M, Boulinguez P, Dhelens C, Ballanger B, Prange S, Bin S, Thobois S. Efficacy and safety of clonidine for the treatment of impulse control disorder in Parkinson's disease: a multicenter, parallel, randomised, double-blind, Phase 2b Clinical trial. J Neurol 2023; 270:4851-4859. [PMID: 37338615 PMCID: PMC10511565 DOI: 10.1007/s00415-023-11814-y] [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: 05/04/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Impulse control disorders (ICDs) are frequently encountered in Parkinson's disease (PD). OBJECTIVES We aimed to assess whether clonidine, an α2-adrenergic receptor agonist, would improve ICDs. METHODS We conducted a multicentre trial in five movement disorder departments. Patients with PD and ICDs (n = 41) were enrolled in an 8-week, randomised (1:1), double-blind, placebo-controlled study of clonidine (75 μg twice a day). Randomisation and allocation to the trial group were carried out by a central computer system. The primary outcome was the change at 8 weeks in symptom severity using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS) score. A reduction of the most elevated subscore of the QUIP-RS of more than 3 points without any increase in the other QUIP-RS dimension defined success. RESULTS Between 15 May 2019 and 10 September 2021, 19 patients in the clonidine group and 20 patients in the placebo group were enrolled. The proportion difference of success in reducing QUIP-RS at 8 weeks, was 7% (one-sided upper 90% CI 27%) with 42.1% of success in the clonidine group and 35.0% in the placebo group. Compared to patients in the placebo group, patients in the clonidine group experienced a greater reduction in the total QUIP-RS score at 8 weeks (11.0 points vs. 3.6). DISCUSSION Clonidine was well tolerated but our study was not enough powerful to demonstrate significant superiority compared to placebo in reducing ICDs despite a greater reduction of total QUIP score at 8 weeks. A phase 3 study should be conducted. TRIAL REGISTRATION The study was registered (NCT03552068) on clinicaltrials.gov on June 11, 2018.
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Affiliation(s)
- Chloé Laurencin
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France.
- Lyon Neuroscience Research Centre, INSERM, University of Lyon, 69622, Lyon, France.
| | - Noémie Timestit
- Department of Biostatistics, University Hospital of Lyon, Lyon, France
| | - Ana Marques
- Department of Neurology, Clermont-Ferrand University Hospital, NS-Park/F-CRIN, Clermont-Ferrand, France
| | | | - Caroline Giordana
- Department of Neurology, University Hospital of Nice, NS-Park/F-CRIN, Nice, France
| | - Sara Meoni
- Movement Disorders Unit, Department of Neurology, University Hospital of Grenoble, NS-Park/F-CRIN, Grenoble, France
| | - Marine Huddlestone
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France
| | - Teodor Danaila
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France
| | - Mathieu Anheim
- Department of Neurology, Strasbourg University Hospital, Strasbourg, France
- Institut de Génétique Et de Biologie Moléculaire Et Cellulaire (IGBMC), INSERM-U964/CNRS, UMR7104/Strasbourg University, Illkirch, France
- Centre de Référence Des Maladies Neurogénétiques Rares, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Hélène Klinger
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France
| | - Tiphaine Vidal
- Department of Neurology, Clermont-Ferrand University Hospital, NS-Park/F-CRIN, Clermont-Ferrand, France
| | - Marion Fatisson
- Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Catherine Caire
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France
| | - Mikail Nourredine
- Department of Biostatistics, University Hospital of Lyon, Lyon, France
- Pharmacotoxicology Laboratory, Department of Clinical Research and Epidemiology, University Hospital of Lyon, Lyon, France
| | - Philippe Boulinguez
- Lyon Neuroscience Research Centre, INSERM, University of Lyon, 69622, Lyon, France
| | - Carole Dhelens
- Pharmacy, FRIPHARM, Edouard Herriot Hospital, Lyon University Hospital, Lyon, France
| | - Bénédicte Ballanger
- Lyon Neuroscience Research Centre, INSERM, University of Lyon, 69622, Lyon, France
| | - Stéphane Prange
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France
- Marc Jeannerod Cognitive Neuroscience Institute, CNRS, UMR 5229, Bron, France
- Faculté de Medecine Et de Maieutique Lyon Sud Charles Mérieux, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Sylvie Bin
- Public Health Center, Research and Clinical Epidemiology, University Hospital of Lyon, Lyon, France
| | - Stéphane Thobois
- Department of Neurology C, Expert Parkinson Centre, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospital, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C - Hospices Civils de Lyon, NS-Park/F-CRIN, 69677, Bron, France
- Marc Jeannerod Cognitive Neuroscience Institute, CNRS, UMR 5229, Bron, France
- Faculté de Medecine Et de Maieutique Lyon Sud Charles Mérieux, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
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Valldeoriola F, Torres V. Predicting impulse control disorder in Parkinson's Disease: Is there a formula? Eur Neuropsychopharmacol 2023; 72:4-5. [PMID: 36930990 DOI: 10.1016/j.euroneuro.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Francesc Valldeoriola
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies, Hospital Clínic of Barcelona, Catalonia, Spain.
| | - Viviana Torres
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies, Hospital Clínic of Barcelona, Catalonia, Spain
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Qamar MA, Rota S, Batzu L, Subramanian I, Falup-Pecurariu C, Titova N, Metta V, Murasan L, Odin P, Padmakumar C, Kukkle PL, Borgohain R, Kandadai RM, Goyal V, Chaudhuri KR. Chaudhuri's Dashboard of Vitals in Parkinson's syndrome: an unmet need underpinned by real life clinical tests. Front Neurol 2023; 14:1174698. [PMID: 37305739 PMCID: PMC10248458 DOI: 10.3389/fneur.2023.1174698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
We have recently published the notion of the "vitals" of Parkinson's, a conglomeration of signs and symptoms, largely nonmotor, that must not be missed and yet often not considered in neurological consultations, with considerable societal and personal detrimental consequences. This "dashboard," termed the Chaudhuri's vitals of Parkinson's, are summarized as 5 key vital symptoms or signs and comprise of (a) motor, (b) nonmotor, (c) visual, gut, and oral health, (d) bone health and falls, and finally (e) comorbidities, comedication, and dopamine agonist side effects, such as impulse control disorders. Additionally, not addressing the vitals also may reflect inadequate management strategies, leading to worsening quality of life and diminished wellness, a new concept for people with Parkinson's. In this paper, we discuss possible, simple to use, and clinically relevant tests that can be used to monitor the status of these vitals, so that these can be incorporated into clinical practice. We also use the term Parkinson's syndrome to describe Parkinson's disease, as the term "disease" is now abandoned in many countries, such as the U.K., reflecting the heterogeneity of Parkinson's, which is now considered by many as a syndrome.
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Affiliation(s)
- Mubasher A. Qamar
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Silvia Rota
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Lucia Batzu
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Parkinson’s Disease Research, Education and Clinical Centers, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, United States
| | - Cristian Falup-Pecurariu
- Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
- Department of Neurology, County Clinic Hospital, Brașov, Romania
| | - Nataliya Titova
- Department of Neurology, Neurosurgery and Medical Genetics, Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation, Moscow, Russia
- Department of Neurodegenerative Diseases, Federal State Budgetary Institution “Federal Center of Brain Research and Neurotechnologies” of the Federal Medical Biological Agency, Moscow, Russia
| | - Vinod Metta
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Lulia Murasan
- Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
- Department of Neurology, County Clinic Hospital, Brașov, Romania
| | - Per Odin
- Department of Neurology, University Hospital, Lund, Sweden
| | | | - Prashanth L. Kukkle
- Center for Parkinson’s Disease and Movement Disorders, Manipal Hospital, Karnataka, India, Bangalore
- Parkinson’s Disease and Movement Disorders Clinic, Bangalore, Karnataka, India
| | - Rupam Borgohain
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Rukmini Mridula Kandadai
- Department of Neurology, Nizam’s Institute of Medical Sciences, Autonomous University, Hyderabad, India
| | - Vinay Goyal
- Neurology Department, Medanta, Gurugram, India
| | - Kallo Ray Chaudhuri
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
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11
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Wang T, Chen X, Zhang J, Feng Q, Huang M. Deep multimodality-disentangled association analysis network for imaging genetics in neurodegenerative diseases. Med Image Anal 2023; 88:102842. [PMID: 37247468 DOI: 10.1016/j.media.2023.102842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/01/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
Imaging genetics is a crucial tool that is applied to explore potentially disease-related biomarkers, particularly for neurodegenerative diseases (NDs). With the development of imaging technology, the association analysis between multimodal imaging data and genetic data is gradually being concerned by a wide range of imaging genetics studies. However, multimodal data are fused first and then correlated with genetic data in traditional methods, which leads to an incomplete exploration of their common and complementary information. In addition, the inaccurate formulation in the complex relationships between imaging and genetic data and information loss caused by missing multimodal data are still open problems in imaging genetics studies. Therefore, in this study, a deep multimodality-disentangled association analysis network (DMAAN) is proposed to solve the aforementioned issues and detect the disease-related biomarkers of NDs simultaneously. First, the imaging data are nonlinearly projected into a latent space and imaging representations can be achieved. The imaging representations are further disentangled into common and specific parts by using a multimodal-disentangled module. Second, the genetic data are encoded to achieve genetic representations, and then, the achieved genetic representations are nonlinearly mapped to the common and specific imaging representations to build nonlinear associations between imaging and genetic data through an association analysis module. Moreover, modality mask vectors are synchronously synthesized to integrate the genetic and imaging data, which helps the following disease diagnosis. Finally, the proposed method achieves reasonable diagnosis performance via a disease diagnosis module and utilizes the label information to detect the disease-related modality-shared and modality-specific biomarkers. Furthermore, the genetic representation can be used to impute the missing multimodal data with our learning strategy. Two publicly available datasets with different NDs are used to demonstrate the effectiveness of the proposed DMAAN. The experimental results show that the proposed DMAAN can identify the disease-related biomarkers, which suggests the proposed DMAAN may provide new insights into the pathological mechanism and early diagnosis of NDs. The codes are publicly available at https://github.com/Meiyan88/DMAAN.
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Affiliation(s)
- Tao Wang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Xiumei Chen
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Jiawei Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Qianjin Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, China; Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou 510515, China.
| | - Meiyan Huang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, China; Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou 510515, China.
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12
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Gerraty RT, Provost A, Li L, Wagner E, Haas M, Lancashire L. Machine learning within the Parkinson's progression markers initiative: Review of the current state of affairs. Front Aging Neurosci 2023; 15:1076657. [PMID: 36861121 PMCID: PMC9968811 DOI: 10.3389/fnagi.2023.1076657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
The Parkinson's Progression Markers Initiative (PPMI) has collected more than a decade's worth of longitudinal and multi-modal data from patients, healthy controls, and at-risk individuals, including imaging, clinical, cognitive, and 'omics' biospecimens. Such a rich dataset presents unprecedented opportunities for biomarker discovery, patient subtyping, and prognostic prediction, but it also poses challenges that may require the development of novel methodological approaches to solve. In this review, we provide an overview of the application of machine learning methods to analyzing data from the PPMI cohort. We find that there is significant variability in the types of data, models, and validation procedures used across studies, and that much of what makes the PPMI data set unique (multi-modal and longitudinal observations) remains underutilized in most machine learning studies. We review each of these dimensions in detail and provide recommendations for future machine learning work using data from the PPMI cohort.
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Affiliation(s)
| | | | - Lin Li
- PharmaLex, Frederick, MD, United States
| | | | - Magali Haas
- Cohen Veterans Bioscience, New York, NY, United States
| | - Lee Lancashire
- Cohen Veterans Bioscience, New York, NY, United States,*Correspondence: Lee Lancashire, ✉
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13
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Leplow B, Renftle D, Thomas M, Michaelis K, Solbrig S, Maetzler W, Berg D, Liepelt-Scarfone I. Characteristics of behavioural addiction in Parkinson's disease patients with self-reported impulse control disorder and controls matched for levodopa equivalent dose: a matched case-control study. J Neural Transm (Vienna) 2023; 130:125-133. [PMID: 36662280 PMCID: PMC9902415 DOI: 10.1007/s00702-023-02588-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023]
Abstract
Impulse control disorders (ICD) in Parkinson's disease (PD) frequently occur, not always as a direct consequence of dopaminergic medication. This study investigated premorbid personality traits and behavioural characteristics in non-demented PD patients with self-reported symptoms of ICD (PD-srICD). From a total of 200 non-demented PD patients who filled out questionnaires assessing symptoms and severity of ICD, those were classified as PD-srICD (n = 32) who reported current occurrence of at least one compulsive behaviour (gambling, sexual behaviour, buying behaviour, or eating). As a control group, 32 patients with no self-reported ICD symptoms were matched for levodopa equivalent daily dose. The demographic, clinical, and premorbid personality profiles were compared between both groups. Frequency of psychological characteristics indicating substance use disorder was evaluated in patients with PD-srICD. Patients with PD-srICD were more frequently male, younger at examination, had earlier PD onset, more depression, higher non-motor burden, less quality of life (p < 0.05, respectively), and more frequently reported premorbid sensation seeking/novelty orientation (p = 0.03) and joyful experience of stress (p = 0.04) than patients in the control group. Of patients with PD-srICD, 90.6% reported at least one behavioural characteristic of substance use disorder, most frequently positive expectations following ICD behaviour and illusional beliefs about its behavioural control. Signs of addiction were common among patients with PD-srICD. Therefore, the profile of psychological characteristics in patients with PD-srICD resembled that of patients with substance use disorder. It can be concluded that dopamine replacement therapy (DRT) alone does not account for PD-srICD and that thorough psychological diagnostics are recommended.
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Affiliation(s)
- Bernd Leplow
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Emil-Abderhalden-Str. 26-27, Halle, 06108, Germany.
| | - Daniela Renftle
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany ,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Mareike Thomas
- Department of Psychology, Martin-Luther-University Halle-Wittenberg, Emil-Abderhalden-Str. 26-27, Halle, 06108 Germany
| | - Katja Michaelis
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany ,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Susanne Solbrig
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany ,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany ,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany ,IB Hochschule für Gesundheit und Soziales, Stuttgart, Germany
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14
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Dulski J, Uitti RJ, Ross OA, Wszolek ZK. Genetic architecture of Parkinson’s disease subtypes – Review of the literature. Front Aging Neurosci 2022; 14:1023574. [PMID: 36337703 PMCID: PMC9632166 DOI: 10.3389/fnagi.2022.1023574] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
The heterogeneity of Parkinson’s disease (PD) has been recognized since its description by James Parkinson over 200 years ago. The complexity of motor and non-motor PD manifestations has led to many attempts of PD subtyping with different prognostic outcomes; however, the pathophysiological foundations of PD heterogeneity remain elusive. Genetic contributions to PD may be informative in understanding the underpinnings of PD subtypes. As such, recognizing genotype-phenotype associations may be crucial for successful gene therapy. We review the state of knowledge on the genetic architecture underlying PD subtypes, discussing the monogenic forms, as well as oligo- and polygenic risk factors associated with various PD subtypes. Based on our review, we argue for the unification of PD subtyping classifications, the dichotomy of studies on genetic factors and genetic modifiers of PD, and replication of results from previous studies.
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Affiliation(s)
- Jarosław Dulski
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
- Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland
- Department of Neurology, St. Adalbert Hospital, Copernicus PL Ltd., Gdańsk, Poland
| | - Ryan J. Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | - Owen A. Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
| | - Zbigniew K. Wszolek
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
- *Correspondence: Zbigniew K. Wszolek,
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