1
|
Townsend LTJ, Anderson KN, Boeve BF, McKeith I, Taylor JP. Sleep disorders in Lewy body dementia: Mechanisms, clinical relevance, and unanswered questions. Alzheimers Dement 2023; 19:5264-5283. [PMID: 37392199 DOI: 10.1002/alz.13350] [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: 12/21/2022] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 07/03/2023]
Abstract
In Lewy body dementia (LBD), disturbances of sleep and/or arousal including insomnia, excessive daytime sleepiness, rapid eye movement (REM) sleep behavior disorder, obstructive sleep apnea, and restless leg syndrome are common. These disorders can each exert a significant negative impact on both patient and caregiver quality of life; however, their etiology is poorly understood. Little guidance is available for assessing and managing sleep disorders in LBD, and they remain under-diagnosed and under-treated. This review aims to (1) describe the specific sleep disorders which occur in LBD, considering their putative or potential mechanisms; (2) describe the history and diagnostic process for these disorders in LBD; and (3) summarize current evidence for their management in LBD and consider some of the ongoing and unanswered questions in this field and future research directions.
Collapse
Affiliation(s)
- Leigh T J Townsend
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kirstie N Anderson
- Regional Sleep Service, Newcastle-upon-Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian McKeith
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
2
|
Mizukami K. Autonomic dysfunction in dementia with Lewy bodies: Focusing on cardiovascular and respiratory dysfunction. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e129. [PMID: 38867816 PMCID: PMC11114397 DOI: 10.1002/pcn5.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 06/14/2024]
Abstract
Dementia with Lewy bodies (DLB) is the second most common cause of dementia after Alzheimer's disease. The disease is characterized by many Lewy bodies appearing in the patient's cerebrum. DLB frequently presents with a variety of autonomic symptoms from the early or prodromal stages of the disease, and these are listed as supportive features in the diagnostic criteria. As several useful assessment methods for evaluating autonomic function in DLB have been reported, this review will focus on cardiovascular and respiratory dysfunction and its assessments. Cardiovascular disorders, such as orthostatic hypotension and abnormal heart rate variability, have been reported in DLB patients. Decreased myocardial uptake by metaiodobenzylguanidine myocardial scintigraphy has been added as an indicative biomarker for DLB in the 2017 revision of the diagnostic criteria. We have reported reduced ventilatory response to hypercapnia, abnormal respiratory rhythm, and high frequency of sleep-disordered breathing as abnormalities of the respiratory regulatory system associated with DLB. Since autonomic dysfunction is highly prevalent in DLB from the early or prodromal phase of the disease and is associated with reduced activities of daily living and quality of life, the evaluation of autonomic dysfunction is also useful in the differential diagnosis of DLB from Alzheimer's disease. There are fewer studies on the respiratory regulatory system than on the cardiovascular system, thus further research is needed to explore its role in DLB.
Collapse
Affiliation(s)
- Katsuyoshi Mizukami
- Graduate School of Comprehensive Human Sciences, Institute of Health and Sport SciencesUniversity of TsukubaBunkyo‐kuTokyoJapan
| |
Collapse
|
3
|
Isik AT, Dost FS, Yavuz I, Ontan MS, Ates Bulut E, Kaya D. Orthostatic hypotension in dementia with Lewy bodies: a meta-analysis of prospective studies. Clin Auton Res 2023; 33:133-141. [PMID: 36862320 DOI: 10.1007/s10286-023-00933-1] [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: 12/09/2022] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Orthostatic hypotension (OH), one of the supportive clinical features in the diagnosis of dementia with Lewy bodies (DLB), is a significant problem in advanced age because of its severe negative consequences. The aim of this meta-analysis was to investigate the prevalence and risk of OH in patients with DLB. METHODS The indexes and databases cited to identify relevant studies were PubMed, ScienceDirect, Cochrane, and Web of Science. The keywords for the search were "Lewy body dementia" and "autonomic dysfunction" or "dysautonomia" or "postural hypotension" or "orthostatic hypotension." English-language articles published from January 1990 to April 2022 were searched. The Newcastle-Ottawa scale was applied to evaluate the quality of the studies. Odds ratios (OR) and risk ratios (RR) were extracted with 95% confidence intervals (CI) and combined using the random effects model after logarithmic transformation. The prevalence in the patients with DLB was also combined using the random effects model. RESULTS Eighteen studies (10 case controls and 8 case series) were included to evaluate the prevalence of OH in patients with DLB. Higher rates of OH were found to be associated with DLB (OR 7.71, 95% CI 4.42, 13.44; p < 0.001), and 50.8% of 662 patients had OH. CONCLUSION DLB increased the risk of OH by 3.62- to 7.71-fold compared to healthy controls. Therefore, it will be useful to evaluate postural blood pressure changes in the follow-up and treatment of patients with DLB.
Collapse
Affiliation(s)
- Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, School of Medicine, Faculty of Medicine, Dokuz Eylul University, Balcova, 35340, Izmir, Turkey.
| | - Fatma Sena Dost
- Department of Geriatric Medicine, Darica State Hospital, Kocaeli, Turkey
| | - Idil Yavuz
- Department of Statistics, Faculty of Science, Dokuz Eylul University, Izmir, Turkey
| | - Mehmet Selman Ontan
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, School of Medicine, Faculty of Medicine, Dokuz Eylul University, Balcova, 35340, Izmir, Turkey
| | - Esra Ates Bulut
- Department of Geriatric Medicine, Adana State Hospital, Adana, Turkey
| | - Derya Kaya
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, School of Medicine, Faculty of Medicine, Dokuz Eylul University, Balcova, 35340, Izmir, Turkey
| |
Collapse
|
4
|
Ghosh S. Breathing disorders in neurodegenerative diseases. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:223-239. [PMID: 36031306 DOI: 10.1016/b978-0-323-91532-8.00008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neurodegenerative disorders are a diverse group of conditions caused by progressive degeneration of neurons resulting in cognitive, motor, sensory, and autonomic dysfunction, leading to severe disability and death. Pulmonary dysfunction is relatively common in these conditions, may be present early in the disease, and is less well recognized and treated than other symptoms. There are variable disorders of upper and lower airways, central control of ventilation, strength of respiratory muscles, and breathing during sleep which further impact daily activities and quality of life and have the potential to injure vulnerable neurons. Laryngopharyngeal dysfunction affects speech, swallowing, and clearance of secretions, increases the risk of aspiration pneumonia, and can cause stridor and sudden death. In Parkinson's disease, L-Dopa benefits some pulmonary symptoms but there are limited pharmacological treatment options for pulmonary dysfunction. Targeted treatments include strengthening of respiratory muscles, positive airway pressure in sleep and techniques to improve cough efficacy. Well-designed clinical trials are needed to evaluate the long-term benefits of these interventions. Challenges for the future include earlier identification of pulmonary dysfunction in the clinic, institution of the most effective treatments (based on clinical trials that measure long-term meaningful outcomes) and the development of neuroprotective treatment.
Collapse
Affiliation(s)
- Soumya Ghosh
- Perron Institute for Neurological and Translational Science, University of Western Australia and Department of Neurology, Sir Charles Gairdner and Perth Children's Hospitals, Nedlands, WA, Australia.
| |
Collapse
|
5
|
Wang X, Luo J, Huang R, Xiao Y. The Elevated Central Chemosensitivity in Obstructive Sleep Apnea Patients with Hypertension. Nat Sci Sleep 2022; 14:855-865. [PMID: 35547180 PMCID: PMC9081185 DOI: 10.2147/nss.s362319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Hypertension is a common comorbidity in obstructive sleep apnea (OSA), in which dysfunction of the autonomic nervous system plays an integral part. Chemoreflex is essential for ventilatory control and cardiovascular activity. This study aimed to determine whether central chemosensitivity was increased in OSA patients with hypertension and the potential role of the autonomic nerve activity in this relationship. PATIENTS AND METHODS A total of 77 men with OSA were included in this cross-sectional study. We measured hypercapnic ventilatory response (HCVR) by the rebreathing method under isoxic hyperoxia to test the central ventilatory chemosensitivity since hyperoxia silences the peripheral chemoreceptors' response to CO2. To elevate the autonomic nerve activity, time-domain, frequency-domain, and non-linear variables of heart rate variability were calculated over 5-min records. Univariate and multivariate linear regression analyses were used to find the determinants of HCVR. RESULTS The median HCVR was 2.3 (1.8, 3.3), 2.1 (1.6, 3.0), and 3 (2.2, 3.7) L/min/mmHg in all participants, OSA patients, and OSA patients with hypertension, respectively. Hypertension was significantly associated with elevated HCVR after adjusting for age, central obesity, OSA severity, daytime sleepiness, and diabetes mellitus. Compared with OSA patients, OSA patients with hypertension had higher body mass index, worse nocturnal hypoxia, and lower time-domain variables and frequency-domain variables. After adjusting for age, apnea-hypopnea index, central obesity, and beta-blocker usage, approximate entropy was independently negatively associated with HCVR in OSA patients with hypertension. CONCLUSION This study demonstrated elevated central chemosensitivity in OSA patients with hypertension. Compared with OSA patients, OSA patients with hypertension had attenuated parasympathetic nerve activity. This study preliminarily illustrated that elevated central chemosensitivity might be associated with weak adaptability of the cardiac autonomic nervous system in OSA patients with hypertension.
Collapse
Affiliation(s)
- Xiaona Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jinmei Luo
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Rong Huang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yi Xiao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| |
Collapse
|
6
|
Burtscher J, Syed MMK, Keller MA, Lashuel HA, Millet GP. Fatal attraction - The role of hypoxia when alpha-synuclein gets intimate with mitochondria. Neurobiol Aging 2021; 107:128-141. [PMID: 34428721 DOI: 10.1016/j.neurobiolaging.2021.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 12/21/2022]
Abstract
Alpha-synuclein aggregation and mitochondrial dysfunction are main pathological hallmarks of Parkinson's disease (PD) and several other neurodegenerative diseases, collectively known as synucleinopathies. However, increasing evidence suggests that they may not be sufficient to cause PD. Here we propose the role of hypoxia as a missing link that connects the complex interplay between alpha-synuclein biochemistry and pathology, mitochondrial dysfunctions and neurodegeneration in PD. We review the partly conflicting literature on alpha-synuclein binding to membranes and mitochondria and its impact on mitochondrial functions. From there, we focus on adverse changes in cellular environments, revolving around hypoxic stress, that may trigger or facilitate PD progression. Inter-dependent structural re-arrangements of mitochondrial membranes, including increased cytoplasmic exposure of mitochondrial cardiolipins and changes in alpha-synuclein localization and conformation are discussed consequences of such conditions. Enhancing cellular resilience could be an integral part of future combination-based therapies of PD. This may be achieved by boosting the capacity of cellular and specifically mitochondrial processes to regulate and adapt to altered proteostasis, redox, and inflammatory conditions and by inducing protective molecular and tissue re-modelling.
Collapse
Affiliation(s)
- Johannes Burtscher
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland; Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.
| | - Muhammed Muazzam Kamil Syed
- Laboratory of Molecular and Chemical Biology of Neurodegeneration, Brain Mind Institute, EPFL, Lausanne, Switzerland
| | - Markus A Keller
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Hilal A Lashuel
- Laboratory of Molecular and Chemical Biology of Neurodegeneration, Brain Mind Institute, EPFL, Lausanne, Switzerland
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
7
|
Omoya R, Miyajima M, Ohta K, Suzuki Y, Aoki A, Fujiwara M, Watanabe T, Yoshida N, Suwa H, Kawara T, Takahashi H, Matsushima E, Takeuchi T. Heart rate response to orthostatic challenge in patients with dementia with Lewy bodies and Alzheimer's disease. Psychogeriatrics 2021; 21:62-70. [PMID: 33089601 DOI: 10.1111/psyg.12625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND To elucidate the differences in autonomic dysfunction between dementia with Lewy bodies (DLB) and Alzheimer's disease using a simple and convenient method, we investigated the heart rate response to orthostatic challenge. METHODS Ninety-seven people participated in this cross-sectional study, and data from 26 DLB patients, 29 Alzheimer's disease patients, and 25 healthy elderly individuals were analysed. Participants underwent postural changes, including 5 min in a supine position, 1 min in a sitting position, and 3 min in an orthostatic position. Their heart rates were continuously recorded. Two heart rate variables were analysed as main outcomes: (i) the difference between heart rate in the sitting position and the peak heart rate within 15 s of orthostasis, defined as the 'early heart rate increase'; and (ii) the difference between the peak heart rate and the negative peak heart rate after this, defined as 'early heart rate recovery.' An early heart rate increase has been considered to reflect parasympathetic and sympathetic functions. Early heart rate recovery is considered to reflect parasympathetic function. We also investigated the frequency domains of resting heart rate variability. RESULTS A significant difference was observed across the three groups in early heart rate increase, and that of the DLB group was lower than that of the healthy control group. Early heart rate recovery also differed significantly across the three groups, and that of the DLB group was less than that of the healthy control group. In addition, the power of the low-frequency component, which represents both sympathetic and parasympathetic activity, was significantly decreased in the DLB group compared to the Alzheimer's disease group. CONCLUSIONS Impaired heart rate response to standing was detected in patients with DLB. Electrocardiogram is a convenient, non-invasive method that might be useful as a subsidiary marker for DLB diagnosis and differentiation from Alzheimer's disease.
Collapse
Affiliation(s)
- Rie Omoya
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Wako Hospital, Saitama, Japan
| | - Miho Miyajima
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsuya Ohta
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Onda-Daini Hospital, Chiba, Japan
| | - Yoko Suzuki
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Ibaraki, Japan
| | - Ai Aoki
- Department of Health Policy, National Centre for Child Health and Development, Tokyo, Japan
| | - Mayo Fujiwara
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Tazaki Hospital, Okinawa, Japan
| | | | - Noriko Yoshida
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Narimasu Kosei Hospital, Tokyo, Japan
| | - Hiroshi Suwa
- Department of Psychiatry, Tokyo Kyosai Hospital, Tokyo, Japan
| | - Tokuhiro Kawara
- Graduate School of Health Care Science, Bunkyo Gakuin University, Tokyo, Japan
| | - Hidehiko Takahashi
- Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eisuke Matsushima
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Takeuchi
- Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
8
|
D'Arrigo A, Floro S, Bartesaghi F, Casellato C, Sferrazza Papa GF, Centanni S, Priori A, Bocci T. Respiratory dysfunction in Parkinson's disease: a narrative review. ERJ Open Res 2020; 6:00165-2020. [PMID: 33043046 PMCID: PMC7533305 DOI: 10.1183/23120541.00165-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/22/2020] [Indexed: 11/18/2022] Open
Abstract
The presence of respiratory symptoms in Parkinson's disease (PD) has been known since the first description of the disease, even though the prevalence and incidence of these disturbances are not well defined. Several causes have been reported, comprising obstructive and restrictive pulmonary disease and changes in the central ventilatory control, and different pathogenetic mechanisms have been postulated accordingly. In our review, we encompass the current knowledge about respiratory abnormalities in PD, as well as the impact of anti-Parkinsonian drugs as either risk or protective factors. A description of putative pathogenetic mechanisms is also provided, and possible treatments are discussed, focusing on the importance of recognising and treating respiratory symptoms as a key manifestation of the disease itself. A brief description of respiratory dysfunctions in atypical Parkinsonism, especially α-synucleinopathies, is also provided. This review addresses current knowledge about respiratory dysfunctions in Parkinson's disease, from the aetiopathology to pharmacological and invasive treatments, describing the different clinical phenotypeshttps://bit.ly/2X7OLtN
Collapse
Affiliation(s)
- Andrea D'Arrigo
- "Aldo Ravelli" Center, Dept of Health Sciences, University of Milan Medical School and San Paolo University Hospital, ASST Santi Paolo e Carlo Milano, Milan, Italy
| | - Stefano Floro
- "Aldo Ravelli" Center, Dept of Health Sciences, University of Milan Medical School and San Paolo University Hospital, ASST Santi Paolo e Carlo Milano, Milan, Italy
| | - Francesca Bartesaghi
- "Aldo Ravelli" Center, Dept of Health Sciences, University of Milan Medical School and San Paolo University Hospital, ASST Santi Paolo e Carlo Milano, Milan, Italy
| | - Chiara Casellato
- "Aldo Ravelli" Center, Dept of Health Sciences, University of Milan Medical School and San Paolo University Hospital, ASST Santi Paolo e Carlo Milano, Milan, Italy
| | - Giuseppe Francesco Sferrazza Papa
- Respiratory Unit, Dept of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy.,Casa di Cura del Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, Dept of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Center, Dept of Health Sciences, University of Milan Medical School and San Paolo University Hospital, ASST Santi Paolo e Carlo Milano, Milan, Italy
| | - Tommaso Bocci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Dept of Health Sciences, University of Milan, Milan, Italy.,III Neurology Clinic, ASST Santi Paolo e Carlo, Milan, Italy
| |
Collapse
|
9
|
Ebihara T, Gui P, Ooyama C, Kozaki K, Ebihara S. Cough reflex sensitivity and urge-to-cough deterioration in dementia with Lewy bodies. ERJ Open Res 2020; 6:00108-2019. [PMID: 32166090 PMCID: PMC7061205 DOI: 10.1183/23120541.00108-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/03/2019] [Indexed: 01/03/2023] Open
Abstract
Cough, an important respiratory symptom, predominantly involves the brainstem and the urge-to-cough (UTC) is modulated by the cerebral cortex. Lewy body disease is associated with decreased cough reflex sensitivity and central respiratory chemosensitivity. Additionally, the insula, associated with the UTC, shows decreased activation and atrophy in dementia with Lewy bodies (DLB). We investigated the relationships between cognition and cough reflex and the UTC and compared the differences in responses of patients with DLB and other dementia subtypes. We conducted a cross-sectional study within a geriatric ward of a university hospital involving elderly patients diagnosed with Alzheimer's disease (AD), DLB, or non-dementia (controls). The cough reflex sensitivities were estimated based on the lowest concentrations of inhaled citric acid that could induce ≥2 coughs (C2) or ≥5 coughs (C5). Subjects were asked to rate the UTC based on the threshold concentrations (Cu) using the modified Borg scale. C2, C5 and Cu were negatively correlated with cognitive function in female participants but not in males (p<0.01). The cough reflex sensitivities expressed as C2 and C5 were significantly higher in the DLB group than in the AD and control groups (p<0.01 adjusted for gender). The UTC threshold expressed as Cu was also significantly higher in the DLB group, while the UTC log–log slope was less responsive in the DLB group than in the other groups. The cough reflex sensitivity and perceived UTC deteriorated in the DLB group more than in the other groups. This result might be valuable in treating patients with DLB. Morbidity and mortality of aspiration pneumonia (AP) in people with dementia are increasing. The cough reflex sensitivity and the urge to cough, which are important responsible factors for AP, are deteriorated in dementia with Lewy bodies.http://bit.ly/2Yyax9w
Collapse
Affiliation(s)
- Takae Ebihara
- Dept of Geriatric Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Peijun Gui
- Dept of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan.,Dept of Rehabilitation Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chika Ooyama
- Dept of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Kozaki
- Dept of Geriatric Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Satoru Ebihara
- Dept of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan.,Dept of Rehabilitation Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
10
|
Vijayan S, Singh B, Ghosh S, Stell R, Mastaglia FL. Brainstem Ventilatory Dysfunction: A Plausible Mechanism for Dyspnea in Parkinson's Disease? Mov Disord 2020; 35:379-388. [DOI: 10.1002/mds.27932] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Srimathy Vijayan
- Perron Institute for Neurological and Translational Sciences Nedlands Perth, Western Australia Australia
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital Nedlands Perth, Western Australia Australia
- School of Human Sciences, University of Western Australia Crawley Western Australia Australia
| | - Soumya Ghosh
- Perron Institute for Neurological and Translational Sciences Nedlands Perth, Western Australia Australia
| | - Rick Stell
- Perron Institute for Neurological and Translational Sciences Nedlands Perth, Western Australia Australia
| | - Frank L Mastaglia
- Perron Institute for Neurological and Translational Sciences Nedlands Perth, Western Australia Australia
| |
Collapse
|
11
|
The pre-Bötzinger complex: Generation and modulation of respiratory rhythm. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
12
|
Toru S, Kanouchi T, Yokota T, Yagi Y, Machida A, Kobayashi T. Utility of Autonomic Function Tests to Differentiate Dementia with Lewy Bodies and Parkinson Disease with Dementia from Alzheimer Disease. Eur Neurol 2017; 79:27-32. [DOI: 10.1159/000484409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/18/2017] [Indexed: 11/19/2022]
Abstract
Objective: We studied autonomic disturbance in patients with dementia with Lewy bodies (DLB), Parkinson disease with dementia (PDD), Alzheimer disease (AD), to determine whether autonomic function tests can be used to distinguish these disorders. Methods: Autonomic function was tested in 56 patients with DLB, 37 patients with PDD, and 59 patients with AD by using the sympathetic skin response, coefficient of variation in R-R interval, the head-up tilt test, serum norepinephrine concentration, and 123I-meta-iodobenzylguanidine cardiac scintigraphy. Symptoms of autonomic dysfunction, such as constipation, urinary symptoms, and orthostatic hypotension, were also noted. Results: The groups did not differ on baseline characteristics other than those associated with Parkinsonism and dementia. All patients with DLB and PDD had some dysautonomia, whereas rates were much lower for patients with AD (19%). Significantly more DLB and PDD patients than AD patients showed abnormalities on autonomic function tests. Conclusions: Autonomic function tests might be quite useful to distinguish DLB and PDD from AD.
Collapse
|
13
|
Manabe T, Mizukami K, Akatsu H, Hashizume Y, Ohkubo T, Kudo K, Hizawa N. Factors Associated with Pneumonia-caused Death in Older Adults with Autopsy-confirmed Dementia. Intern Med 2017; 56:907-914. [PMID: 28420838 PMCID: PMC5465406 DOI: 10.2169/internalmedicine.56.7879] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective A better understanding of risk factors for pneumonia-caused death may help to improve the clinical management of dementia. Methods A retrospective observational study was conducted by reviewing the medical charts and autopsy reports of 204 patients who were admitted to hospital, underwent a post-mortem examination, and who were neuropathologically diagnosed with dementia. The risk factors for pneumonia-caused death were examined both as underlying and immediate causes of death using logistic regression models. Results A high frequency of pneumonia-caused death was observed both in underlying- (37.3%) and immediate- (44.1%) cause of death, but varied according to the subtypes of dementia. The factors related to pneumonia-caused death (underlying) were subtypes of dementia; Alzheimer's disease (odds ratio [OR], 2.891; 95% confidence interval [CI], 1.459-5.730); argyrophilic grain disease (OR, 3.148; 95% CI, 0.937-10.577); and progressive supranuclear palsy (OR, 34.921; 95% CI, 3.826-318.775), dysphagia (OR, 2.045; 95% CI, 1.047-3.994), diabetes mellitus (OR, 3.084; 95% CI, 1.180-8.061) and conversely related with heart failure (OR, 0.149; 95% CI, 0.026-0.861). Factors relating to pneumonia-caused death (immediate) were incidence of pneumonia during hospitalizations (OR, 32.579; 95%CI, 4.308-246.370), gender-male (OR, 2.060; 95% CI, 1.098-3.864), and conversely related with malignant neoplasm (OR, 0.220; 95% CI, 0.058-0.840). Conclusion The different factors relating to the pneumonia-caused death were evaluated depending on whether pneumonia was the underlying- or immediate-cause of death. Strengthening clinical management on dysphagia and diabetes mellitus, and preventing incidence of pneumonia during hospitalization appear to be the important for the terminal stage of hospitalized patients with dementia.
Collapse
Affiliation(s)
- Toshie Manabe
- Department of Pulmonary Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Japan
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Japan
- Waseda University Organization of Asia Human Community, Japan
- Department of Social Health and Stress Management, Graduate School of Comprehensive Human Science, University of Tsukuba, Japan
| | - Katsuyoshi Mizukami
- Department of Social Health and Stress Management, Graduate School of Comprehensive Human Science, University of Tsukuba, Japan
- Faculty of Health and Sport Sciences, University of Tsukuba, Japan
| | - Hiroyasu Akatsu
- Choju Medical Institute, Fukushimura Hospital, Japan
- Department of Community-based Medicine, Nagoya City University Graduate School of Medicine, Japan
| | | | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Japan
| | - Koichiro Kudo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Japan
- Yurin Hospital, Japan
| | - Nobuyuki Hizawa
- Department of Pulmonary Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Japan
| |
Collapse
|
14
|
Takahashi S, Mizukami K, Arai T, Ogawa R, Kikuchi N, Hattori S, Darby D, Asada T. Ventilatory Response to Hypercapnia Predicts Dementia with Lewy Bodies in Late-Onset Major Depressive Disorder. J Alzheimers Dis 2016; 50:751-8. [PMID: 26757183 DOI: 10.3233/jad-150507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies have shown that developing major depressive disorder (MDD) at 50 years of age or older can predict dementia. Depression is particularly common in dementia with Lewy bodies (DLB), and occasionally occurs before the onset of extrapyramidal symptoms. Moreover, systemic autonomic dysfunction, including an abnormal ventilatory response to hypercapnia (VRH), is common in patients with DLB. OBJECTIVE Here, we aimed to determine whether the VRH is useful for distinguishing depression that is predictive of DLB from other types of MDD. METHODS Participants were 35 consecutive patients with first onset MDD at 50 years or older with bradykinesia. After diagnosing the clinical subtype of MDD according to DSM-IV criteria, each subject underwent a battery of psychological tests, autonomic examinations including VRH, brain magnetic resonance imaging, and 123I-meta-iodobenzylguanidine scintigraphy. RESULTS Longitudinal follow-up showed that all 18 patients with abnormal VRH results developed DLB, whereas none of the 17 patients with normal VRH results converted to DLB within the study period (sensitivity: 100% , specificity: 100%). Additionally, over half of the DLB converters showed abnormalities on other autonomic examinations. For converters, the most common MDD subtype had psychotic and melancholic features simultaneously. The frequency of hypersensitivity to psychotropics was higher in converters than it was in non-converters. CONCLUSION In the present study, patients with abnormal VRH results were very likely to develop DLB. Thus, for patients with late-onset MDD accompanied by bradykinesia, the VRH in combination with the clinical subtype of MDD or hypersensitivity to psychotropics may be useful for diagnosing prodromal DLB.
Collapse
Affiliation(s)
- Sho Takahashi
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Department of Disaster Psychiatry, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Katsuyoshi Mizukami
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Tetsuaki Arai
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ryoko Ogawa
- Department of Pulmonology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Norihiro Kikuchi
- Department of Pulmonology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Satoshi Hattori
- Biostatistics Center, Kurume University, Kurume, Fukuoka, Japan
| | - David Darby
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville VIC, Australia
| | | |
Collapse
|
15
|
Manabe T, Mizukami K, Akatsu H, Teramoto S, Yamaoka K, Nakamura S, Ohkubo T, Kudo K, Hizawa N. Influence of pneumonia complications on the prognosis of patients with autopsy-confirmed Alzheimer's disease, dementia with Lewy bodies, and vascular dementia. Psychogeriatrics 2016; 16:305-14. [PMID: 26510708 DOI: 10.1111/psyg.12163] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/24/2015] [Accepted: 09/25/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Pneumonia is a major, complicated disease in patients with dementia. However, the influence of pneumonia on the prognosis of patients with varying types of dementia has not been fully evaluated. METHODS We retrospectively analyzed the data from medical and autopsy reports. All study patients had been hospitalized and underwent brain autopsy in a hospital in Toyohashi, Japan, between 2005 and 2014. The patients with subtypes of dementia, specifically Alzheimer's disease (AD), dementia with Lewy bodies (DLB), or vascular dementia (VaD), were neuropathologically diagnosed and examined. Pneumonia incidence, cause of death, and the clinical time-course of dementia were compared among the dementia subtypes. The time to death from dementia onset (survival time) was compared by the Kaplan-Meier method among subtypes of dementia with or without pneumonia. Risk factors for survival time on all study patients were analyzed with the Cox proportional hazard model. RESULTS Of the 157 eligible patients, 63 (40.1%) had AD, 42 (26.8%) had DLB, and 52 (33.1%) had VaD. Pneumonia complication was observed with high incidence in each subtype of dementia, especially in DLB (90.5%). The median total duration from dementia onset to death was 8 years in AD and DLB, and 5 years in VaD. The VaD subtype had more male patients than AD or DLB (P = 0.010), and age of death in this group was the youngest among the three groups (P = 0.018). A significant difference was observed in the survival time by the Kaplan-Meier method among the three groups (P < 0.001) and among the groups with pneumonia (P = 0.002). The factors associated with shorter survival time were male gender, pneumonia complications, diabetes mellitus, age of dementia onset ≥ 75 years, and VaD. CONCLUSIONS Pneumonia complications shortened the survival time of patients with AD, DLB, and VaD.
Collapse
Affiliation(s)
- Toshie Manabe
- Department of Social Health and Stress Management, University of Tsukuba, Tsukuba, Japan.,Department of Pulmonary Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan.,Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Katsuyoshi Mizukami
- Department of Social Health and Stress Management, University of Tsukuba, Tsukuba, Japan. .,Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.
| | - Hiroyasu Akatsu
- Department of Community-based Medicine, Nagoya City University Graduate School of Medicine, Nagoya, Japan.,Choju Medical Institute, Fukushimura Hospital, Toyohashi, Japan
| | - Shinji Teramoto
- Department of Pulmonary Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Kazue Yamaoka
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Seiji Nakamura
- Department of Social Health and Stress Management, University of Tsukuba, Tsukuba, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Koichiro Kudo
- Organization of Asia Human Community, Waseda University, Tokyo, Japan.,Department of Infection Control and Respiratory Medicine, Koto Hospital, Tokyo, Japan
| | - Nobuyuki Hizawa
- Department of Pulmonary Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
16
|
Muñoz-Ortiz J, Muñoz-Ortiz E, López-Meraz ML, Beltran-Parrazal L, Morgado-Valle C. Pre-Bötzinger complex: Generation and modulation of respiratory rhythm. Neurologia 2016; 34:461-468. [PMID: 27443242 DOI: 10.1016/j.nrl.2016.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/14/2016] [Accepted: 05/09/2016] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION In mammals, the preBötzinger complex (preBötC) is a bilateral and symmetrical neural network located in the brainstem which is essential for the generation and modulation of respiratory rhythm. There are few human studies about the preBötC and, its relationship with neurological diseases has not been described. However, the importance of the preBötC in neural control of breathing and its potential participation in neurological diseases in humans, has been suggested based on pharmacological manipulation and lesion of the preBötC in animal models, both in vivo and in vitro. METHOD In this review, we describe the effects of some drugs on the inspiratory activity in vitro in a transverse slice that contains the preBötC, as well as some in vivo experiments. Drugs were classified according to their effects on the main neurotransmitter systems and their importance as stimulators or inhibitors of preBötC activity and therefore for the generation of the respiratory rhythm. CONCLUSION Clinical neurologists will find this information relevant to understanding how the central nervous system generates the respiratory rhythm and may also relate this information to the findings made in daily practice.
Collapse
Affiliation(s)
- J Muñoz-Ortiz
- Doctorado en Investigaciones Cerebrales, Universidad Veracruzana, Xalapa de Enríquez, Veracruz, México
| | - E Muñoz-Ortiz
- Doctorado en Investigaciones Cerebrales, Universidad Veracruzana, Xalapa de Enríquez, Veracruz, México
| | - M L López-Meraz
- Centro de Investigaciones Cerebrales, Dirección General de Investigaciones, Universidad Veracruzana, Xalapa de Enríquez, Veracruz, México
| | - L Beltran-Parrazal
- Centro de Investigaciones Cerebrales, Dirección General de Investigaciones, Universidad Veracruzana, Xalapa de Enríquez, Veracruz, México
| | - C Morgado-Valle
- Centro de Investigaciones Cerebrales, Dirección General de Investigaciones, Universidad Veracruzana, Xalapa de Enríquez, Veracruz, México.
| |
Collapse
|
17
|
Manabe T, Mizukami K, Akatsu H, Hashizume Y, Teramoto S, Nakamura S, Kudo K, Hizawa N. Prognostic Factors Related to Dementia with Lewy Bodies Complicated with Pneumonia: An Autopsy Study. Intern Med 2016; 55:2771-2776. [PMID: 27725535 PMCID: PMC5088536 DOI: 10.2169/internalmedicine.55.6868] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective In patients demonstrating dementia with Lewy bodies (DLB), pneumonia is a common complication. However, the prognostic factors for the survival time in DLB with pneumonia have not been investigated by autopsy in patients with neuropathologically confirmed DLB. Methods We conducted a retrospective study of the medical and autopsy reports of 42 patients admitted to a Japanese hospital between 2005 and 2014. The patients were neuropathologically diagnosed as having DLB by post-mortem examinations. We analyzed the effects of various factors on the time from DLB onset to death. Results Thirty-nine of the 42 patients with DLB (92.9%) developed pneumonia during hospitalization. The median age at DLB onset was 78 years and the median time from DLB onset to death was 8 years. The Cox proportional hazard model demonstrated cerebral infarction [Hazard Ratio (HR), 2.36 (95% CI 1.12-4.96), p=0.023], muscle weakness [HR, 2.04 (0.95-4.39), p=0.067], male sex [HR, 2.84 (1.24-6.50), p=0.014], and age at onset (≥78 years.) [HR, 4.71 (1.82-12.18), p=0.001] to be prognostic factors for a shorter time from DLB onset to death. Conclusion Careful treatment of cerebral infarction and muscle weakness of the lower extremities is crucial for DLB patients with pneumonia, especially for those over 78 years of age, in order to maximize the patients' life expectancies.
Collapse
Affiliation(s)
- Toshie Manabe
- Department of Social Health and Stress Management, Graduate School of Comprehensive Human Science, University of Tsukuba, Japan
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Shimada H, Hirano S, Sinotoh H, Ota T, Tanaka N, Sato K, Yamada M, Fukushi K, Irie T, Zhang MR, Higuchi M, Kuwabara S, Suhara T. Dementia with Lewy bodies can be well-differentiated from Alzheimer's disease by measurement of brain acetylcholinesterase activity-a [11C]MP4A PET study. Int J Geriatr Psychiatry 2015; 30:1105-13. [PMID: 26280153 DOI: 10.1002/gps.4338] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the diagnostic performance of brain acetylcholinesterase (AChE) activity measurement using N-[(11) C]-methyl-4-piperidyl acetate (MP4A) and PET in patients with dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). METHODS Participants were 14 DLB patients, 25 AD patients and 18 age-matched healthy controls (HC). All subjects underwent PET scans and MP4A to measure regional brain AChE activity. We performed anatomical standardization of each brain image, and k3 values, an index of AChE activity, in each voxel were estimated by nonlinear least squares analysis. Volumes of interest (VOIs) were identified on parametric k3 images in frontal, temporal, parietal and occipital cortices, and in anterior and posterior cingulate gyri (ACG and PCG). In each VOI, the differential diagnostic performance between AD and DLB of k3 values was assessed by area under the curve (AUC) of the receiver-operating characteristic. Voxel-based statistical analyses were also performed. RESULTS Mean cortical AChE activities in AD patients (-8.2% compared with normal mean) and DLB patients (-27.8%) were lower than HCs (p < 0.05, p < 0.001, respectively). There was a significant difference in mean cortical AChE activities between AD and DLB patients (p < 0.001). All regional brain AChE activities of defined VOIs except ACG were able to well discriminate DLB from AD, and notably performance was the most significant in PCG (AUC = 0.989, 95% CI: 0.965-1.000). CONCLUSIONS Brain cholinergic deficit is consistently prominent in DLB compared with AD. PET measurement of brain AChE activity may be useful for the differential diagnosis between DLB and AD.
Collapse
Affiliation(s)
- H Shimada
- Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba-shi, Chiba, Japan
| | - S Hirano
- Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba-shi, Chiba, Japan.,Department of Neurology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, Japan
| | - H Sinotoh
- Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba-shi, Chiba, Japan.,Neurology Chiba Clinic, Chiba-shi, Chiba, Japan
| | - T Ota
- Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba-shi, Chiba, Japan.,Department of Psychiatry, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - N Tanaka
- Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba-shi, Chiba, Japan
| | - K Sato
- Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba-shi, Chiba, Japan.,Department of Psychiatry, Teikyo University Chiba Medical Center, Ichihara-shi, Chiba, Japan
| | - M Yamada
- Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba-shi, Chiba, Japan.,Precursory Research for Embryonic Science and Technology, Japan Science and Technology Agency, Chiyoda-ku, Tokyo, Japan
| | - K Fukushi
- Molecular Probe Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba-shi, Chiba, Japan
| | - T Irie
- Molecular Probe Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba-shi, Chiba, Japan
| | - M R Zhang
- Molecular Probe Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba-shi, Chiba, Japan
| | - M Higuchi
- Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba-shi, Chiba, Japan
| | - S Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, Japan
| | - T Suhara
- Molecular Neuroimaging Program, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba-shi, Chiba, Japan
| |
Collapse
|
19
|
Abstract
Dementia with Lewy bodies (DLB) is the second most common form of dementia, and it is very frequently associated with changes in sleep patterns. To date, the literature has focused mainly on REM sleep behavior as the most prominent sleep disorder in DLB while little is known about the prevalence and the impact of sleep-disordered breathing (SDB) in DLB. Clinicians should be aware that the clinical diagnosis of SDB in DLB is difficult to establish and that the risk of overlooking SDB in patients with DLB is substantial. Polysomnographic sleep investigations may therefore be advisable in patients with DLB in order to objectify their sleep respiratory patterns. The available literature data on this topic, which are very limited and based on small case series, indicate that SDB occurs in 34.8 to 60% of patients with DLB. SDB can be hypothesized to coexist with other sleep-related disorders in an interactive loop: SDB alters sleep continuity, which can in turn facilitate nocturnal and daytime vigilance-dependent phenomena. There is an absolute need for prospective, preferably multi-center, controlled trials to establish whether, and to what extent, SDB might affect neuropsychological performances in patients with DLB and whether its treatment can improve residual daytime functioning in these patients.
Collapse
Affiliation(s)
- Raffaele Manni
- Sleep Medicine and Epilepsy Unit, C. Mondino National Neurological Institute, Pavia, Italy,
| | | |
Collapse
|
20
|
Presti MF, Schmeichel AM, Low PA, Parisi JE, Benarroch EE. Degeneration of brainstem respiratory neurons in dementia with Lewy bodies. Sleep 2014; 37:373-8. [PMID: 24501436 DOI: 10.5665/sleep.3418] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Respiratory dysfunction, including sleep disordered breathing, is characteristic of multiple system atrophy (MSA) and may reflect degeneration of brainstem respiratory nuclei involved in respiratory rhythmogenesis and chemosensitivity, including the pre-Bötzinger complex (preBötC), nucleus raphe pallidus (RPa), and nucleus raphe obscurus (ROb). However, impaired ventilatory responses to hypercapnia have also been reported in dementia with Lewy bodies (DLB), suggesting that these nuclei may also be affected in DLB. OBJECTIVES To determine whether there is involvement of the preBötC, RPa, and ROb in DLB. DESIGN We applied stereological methods to analyze sections immunostained for neurokinin-1 receptor and tryptophan hydroxylase in neuropathologically confirmed cases of DLB, MSA, and controls. RESULTS Reduction of neuronal density occurred in all three nuclei in DLB, as well as in MSA. The magnitude of neuronal depletion in ROb was similar in DLB and MSA (49% versus 56% respectively, compared to controls, P < 0.05), but neuronal loss in the preBötC and RPa was less severe in DLB than in MSA (40% loss in preBötC of DLB, P < 0.05 and 68% loss in MSA, P < 0.0001, compared to controls; 46% loss in RPa of DLB, P < 0.05 and 73% loss in MSA P < 0.0001, compared to controls). CONCLUSIONS Medullary respiratory nuclei are affected in dementia with Lewy bodies but less severely than in multiple system atrophy. This may help explain differences in the frequency of sleep disordered breathing in these two disorders.
Collapse
Affiliation(s)
| | | | | | - Joseph E Parisi
- Department of Neurology ; Division of Anatomical Pathology, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
21
|
Chiba Y, Fujishiro H, Iseki E, Ota K, Kasanuki K, Hirayasu Y, Satoa K. Retrospective survey of prodromal symptoms in dementia with Lewy bodies: comparison with Alzheimer's disease. Dement Geriatr Cogn Disord 2012; 33:273-81. [PMID: 22722638 DOI: 10.1159/000339363] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-motor symptoms are recognized to enable the early detection of Parkinson's disease (PD). It remains unknown when those symptoms appear in dementia with Lewy bodies (DLB). METHOD We investigated the prevalence of 15 non-motor symptoms of PD at the onset of memory loss based on a standardized worksheet in 34 patients with DLB, 32 patients with Alzheimer's disease (AD) and 30 normal controls. RESULTS DLB patients exhibited a significantly higher prevalence of olfactory dysfunction, constipation, increased saliva and signs of rapid eye movement sleep behavior disorder at the onset of memory loss than AD patients and normal controls. CONCLUSIONS Paying attention to non-motor symptoms of PD may help DLB diagnosis in the early stage, especially in terms of its differentiation from AD.
Collapse
Affiliation(s)
- Yuhei Chiba
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|
22
|
Idiaquez J, Roman GC. Autonomic dysfunction in neurodegenerative dementias. J Neurol Sci 2011; 305:22-7. [PMID: 21440258 DOI: 10.1016/j.jns.2011.02.033] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 02/19/2011] [Accepted: 02/28/2011] [Indexed: 12/20/2022]
Abstract
Syncope associated to orthostatic hypotension (OH), urinary incontinence and constipation is common symptoms in demented patients, mainly in dementia with Lewy bodies (DLB) and in Parkinson's disease dementia (PDD). Alzheimer's disease (AD) and fronto temporal lobar degeneration (FTLD) show less autonomic dysfunction. Urinary symptoms are a prominent component of normal pressure hydrocephalus (NPH). There are non invasive tests including standard cardiovascular tests, 123 I-metaiodobenzylguanide (MIBG) cardiac scintigraphy, urodynamic tests, gastrointestinal motility studies, sweating reflexes and pupillary responses that assess autonomic dysfunction in these patients. The study of autonomic symptoms and abnormal tests in patients with dementia is useful to prevent morbidity due falls, severe constipation and to avoid side effects of drugs that interfere with autonomic function.
Collapse
Affiliation(s)
- Juan Idiaquez
- Universidad de Valparaíso, Avenida Libertad 63, Viña del Mar, Chile.
| | | |
Collapse
|
23
|
Respiratory problems in neurologic movement disorders. Parkinsonism Relat Disord 2010; 16:628-38. [DOI: 10.1016/j.parkreldis.2010.07.004] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 07/03/2010] [Accepted: 07/07/2010] [Indexed: 01/31/2023]
|
24
|
Treglia G, Cason E. Diagnostic performance of myocardial innervation imaging using MIBG scintigraphy in differential diagnosis between dementia with lewy bodies and other dementias: a systematic review and a meta-analysis. J Neuroimaging 2010; 22:111-7. [PMID: 21091814 DOI: 10.1111/j.1552-6569.2010.00532.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND PURPOSE This study was designed to review the diagnostic performance of myocardial innervation imaging using iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy in differential diagnosis between dementia with Lewy bodies (DLB) and other dementias. METHODS A comprehensive computer literature search of studies published through May 2010 regarding MIBG scintigraphy in patients with DLB was performed in PubMed/MEDLINE and Embase databases. Only studies in which MIBG scintigraphy was performed for differential diagnosis between DLB and other dementias were selected. Pooled sensitivity and specificity of MIBG scintigraphy were presented with a 95% confidence interval (CI). The area under the ROC curve was calculated to measure the accuracy of MIBG scintigraphy in differential diagnosis between Lewy body diseases and other dementias. RESULTS Ultimately, we identified 8 studies comprising a total of 346 patients with dementia (152 patients with DLB and 194 patients with other dementias). The pooled sensitivity of MIBG scintigraphy in detection of DLB was 98% (95% CI, 94-100%); the pooled specificity of MIBG scintigraphy in differential diagnosis between DLB and other dementias was 94% (95% CI, 90-97%). The area under the ROC curve was .99. CONCLUSIONS Myocardial innervation imaging with MIBG scintigraphy demonstrated high pooled sensitivity and specificity in patients with suspected DLB. MIBG scintigraphy is an accurate test for differential diagnosis between DLB and other dementias.
Collapse
Affiliation(s)
- Giorgio Treglia
- Institute of Nuclear Medicine, Policlinico Gemellli, Catholic University of the Sacred Heart, Rome, Italy.
| | | |
Collapse
|
25
|
Meissner WG, Vital A, Ghorayeb I, Guehl D, Tison F. Dyspnea as first sign of autonomic failure in postmortem confirmed multiple system atrophy. Mov Disord 2010; 25:1997-8. [DOI: 10.1002/mds.23182] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
26
|
Takahashi S, Mizukami K, Yasuno F, Asada T. Depression associated with dementia with Lewy bodies (DLB) and the effect of somatotherapy. Psychogeriatrics 2009; 9:56-61. [PMID: 19604326 DOI: 10.1111/j.1479-8301.2009.00292.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) is a common type of dementia. It is difficult to make an initial diagnosis of DLB because of a variety of early symptoms, including psychosis-like and depressive states. In this study, we examined the characteristic depressive symptoms of the prestage of DLB and the efficacy and safety of somatotherapy for depression accompanying DLB. METHODS Subjects in the study were 167 consecutive clinical cases aged 50 years or more, hospitalized at Tsukuba University Hospital from December 2002 to September 2007. At the time of admission, patients were diagnosed with certain types of mood disorders according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision. For each subject, a series of neuropsychological tests, along with a standard psychiatric and neurological assessment and biological examinations, were conducted. Using the data from these exams, we diagnosed probable and possible DLB according to the criteria for dementia with Lewy bodies established by McKeith et al. 1 We compared patients' depressive symptoms according to the Hamilton Depression Scale, and distinguished between patients with depression associated with DLB and those with other mood disorders. 2 We also examined the efficacy and safety of somatotherapy (electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS)) for patients with drug therapy-resistant depression associated with DLB. RESULTS 1 The characteristic symptoms of patients with DLB were classified into two groups: psychotic and non-psychotic. The former consisted of patients with states such as delusion and agitation, and the latter included patients exhibiting psychomotor retardation, loss of insight and hypochondriasis. 2 Eight DLB patients with therapy-resistant depression underwent ECT. After ECT, significant improvement was observed, with no remarkable safety hazards. Six patients with drug therapy-resistant DLB underwent TMS. TMS appears to be an effective, safe remedy for this kind of patient. CONCLUSIONS A total of 13.8% of patients came to be re-diagnosed as having DLB as a consequence of a thorough examination after admission. Patients with depression associated with DLB were classified into psychotic and non-psychotic clusters. ECT and TMS are effective and safe therapeutic tools for drug therapy-resistant depression observed in DLB patients.
Collapse
Affiliation(s)
- Sho Takahashi
- Clinical Neuroscience, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
| | | | | | | |
Collapse
|