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Bode M, Kalbe E, Liepelt-Scarfone I. Cognition and Activity of Daily Living Function in people with Parkinson's disease. J Neural Transm (Vienna) 2024; 131:1159-1186. [PMID: 38976044 DOI: 10.1007/s00702-024-02796-w] [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: 04/12/2024] [Accepted: 06/08/2024] [Indexed: 07/09/2024]
Abstract
The ability to perform activities of daily living (ADL) function is a multifaceted construct that reflects functionality in different daily life situations. The loss of ADL function due to cognitive impairment is the core feature for the diagnosis of Parkinson's disease dementia (PDD). In contrast to Alzheimer's disease, ADL impairment in PD can be compromised by various factors, including motor and non-motor aspects. This narrative review summarizes the current state of knowledge on the association of cognition and ADL function in people with PD and introduces the concept of "cognitive ADL" impairment for those problems in everyday life that are associated with cognitive deterioration as their primary cause. Assessment of cognitive ADL impairment is challenging because self-ratings, informant-ratings, and performance-based assessments seldomly differentiate between "cognitive" and "motor" aspects of ADL. ADL function in PD is related to multiple cognitive domains, with attention, executive function, and memory being particularly relevant. Cognitive ADL impairment is characterized by behavioral anomalies such as trial-and-error behavior or task step omissions, and is associated with lower engagement in everyday behaviors, as suggested by physical activity levels and prolonged sedentary behavior. First evidence shows that physical and multi-domain interventions may improve ADL function, in general, but the evidence is confounded by motor aspects. Large multicenter randomized controlled trials with cognitive ADL function as primary outcome are needed to investigate which pharmacological and non-pharmacological interventions can effectively prevent or delay deterioration of cognitive ADL function, and ultimately the progression and conversion to PDD.
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Affiliation(s)
- Merle Bode
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Eberhard Karls University Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Cologne, Germany
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Inga Liepelt-Scarfone
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Eberhard Karls University Tübingen, Hoppe-Seyler Str. 3, 72076, Tübingen, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.
- IB-Hochschule, Stuttgart, Germany.
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Liepelt-Scarfone I, Ophey A, Kalbe E. Cognition in prodromal Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:93-111. [PMID: 35248208 DOI: 10.1016/bs.pbr.2022.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
One characteristic of Parkinson's disease (PD) is a prodromal phase, lasting many years during which both pre-clinical motor and non-motor symptoms occur. Around one-fifth of patients with PD manifest mild cognitive impairment at time of clinical diagnosis. Thus, important challenges are to define the time of onset of cognitive dysfunction in the prodromal phase of PD, and to define its co-occurrence with other specific characteristics. Evidence for cognitive change in prodromal PD comes from various study designs, including both longitudinal and cross-sectional approaches with different target groups. These studies support the concept that changes in global cognitive function and alterations in executive functions occur, and that these changes may be present up to 6 years before clinical PD diagnosis. Notably, this evidence led to including global cognitive impairment as an independent prodromal marker in the recently updated research criteria of the Movement Disorder Society for prodromal PD. Knowledge in this field, however, is still at its beginning, and evidence is sparse about many aspects of this topic. Further longitudinal studies including standardized assessments of global and domain-specific cognitive functions are needed to gain further knowledge about the first appearance, the course, and the interaction of cognitive deficits with other non-motor symptoms in prodromal stage PD. Treatment approaches, including non-pharmacological interventions, in individuals with prodromal PD might help to prevent or delay cognitive dysfunction in early PD.
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Affiliation(s)
- Inga Liepelt-Scarfone
- German Center for Neurodegenerative Diseases (DZNE) and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany; IB-Hochschule, Stuttgart, Germany.
| | - Anja Ophey
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne and Medical Faculty of the University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne and Medical Faculty of the University of Cologne, Cologne, Germany
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Abstract
Cognitive impairment affects up to 80% of patients with Parkinson's disease (PD) and is associated with poor quality of life. PD cognitive dysfunction includes poor working memory, impairments in executive function and difficulty in set-shifting. The pathophysiology underlying cognitive impairment in PD is still poorly understood, but there is evidence to support involvements of the cholinergic, dopaminergic, and noradrenergic systems. Only rivastigmine, an acetyl- and butyrylcholinesterase inhibitor, is efficacious for the treatment of PD dementia, which limits management of cognitive impairment in PD. Whereas the role of the serotonergic system in PD cognition is less understood, through its interactions with other neurotransmitters systems, namely, the cholinergic system, it may be implicated in cognitive processes. In this chapter, we provide an overview of the pharmacological, clinical and pathological evidence that implicates the serotonergic system in mediating cognition in PD.
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Bougea A, Maraki MI, Yannakoulia M, Stamelou M, Xiromerisiou G, Kosmidis MH, Ntanasi E, Dardiotis E, Hadjigeorgiou GM, Sakka P, Anastasiou CA, Stefanis L, Scarmeas N. Higher probability of prodromal Parkinson disease is related to lower cognitive performance. Neurology 2019; 92:e2261-e2272. [PMID: 30944240 DOI: 10.1212/wnl.0000000000007453] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/11/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Given the limited information on cognitive function before Parkinson disease (PD) clinical onset in the general population, we sought to assess prodromal PD (pPD) probability and relate it to detailed cognitive performance in a community cohort. METHODS In a population-based cohort of 1,629 dementia-free and PD-free participants ≥65 years of age in Greece, we assessed probability of pPD according to the International Parkinson and Movement Disorder Society's criteria. Clinical cognitive diagnoses (cognitively unimpaired, mild cognitive impairment [MCI], dementia) considering neuropsychological testing and functional status were assigned in consensus conferences. Cognitive performance in 5 cognitive domains was assessed by a detailed neuropsychological battery and summarized in the form of z scores. We investigated associations between pPD probability (and its individual constituents) and cognitive outcomes. RESULTS The median probability of pPD was 1.81% (0.2%-96.7%). Participants with MCI had higher probability of pPD compared to those with normal cognition (p < 0.001). Higher probability of pPD was related to lower performance in all cognitive domains (memory, language, executive, attention, and visuospatial function) (p < 0.001). Lower cognitive performance was further associated with certain nonmotor markers of pPD, such as daytime somnolence, depression, urinary dysfunction, constipation, and subthreshold parkinsonism (p < 0.001). CONCLUSIONS Higher probability of pPD was associated with lower cognitive performance in all domains and higher probability of MCI. This may reflect a widespread pathologic process although future studies are warranted to infer causality. These results suggest to clinicians that they should assess cognition early, and to researchers that they should further look into the possible mechanisms that may underlie this observation.
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Affiliation(s)
- Anastasia Bougea
- From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Maria I Maraki
- From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Mary Yannakoulia
- From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Maria Stamelou
- From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Georgia Xiromerisiou
- From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Mary H Kosmidis
- From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Eva Ntanasi
- From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Efthimios Dardiotis
- From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Georgios M Hadjigeorgiou
- From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Paraskevi Sakka
- From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Costas A Anastasiou
- From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Leonidas Stefanis
- From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY
| | - Nikolaos Scarmeas
- From the 1st Department of Neurology (A.B., E.N., C.A.A., L.S., N.S.), Aiginition Hospital, National and Kapodistrian, University of Athens Medical School; Department of Nutrition and Dietetics (M.I.M., M.Y., E.N., C.A.A.), Harokopio University; Parkinson's Disease and Movement Disorders Department (M.S.), Hygeia Hospital, Athens, Greece; Department of Neurology (M.S.), Philipps University, Marburg, Germany; School of Medicine (G.X., E.D., G.M.H.), University of Thessaly, Larissa; Laboratory of Cognitive Neuroscience, School of Psychology (M.H.K.), Aristotle University of Thessaloniki, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus; Athens Association of Alzheimer's Disease and Related Disorders (E.N., P.S.), Maroussi; Center of Clinical, Experimental Surgery and Translational Research (L.S.), Biomedical Research Foundation of the Academy of Athens, Greece; and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (N.S.), The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, NY.
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Fengler S, Liepelt-Scarfone I, Brockmann K, Schäffer E, Berg D, Kalbe E. Cognitive changes in prodromal Parkinson's disease: A review. Mov Disord 2017; 32:1655-1666. [PMID: 28980730 DOI: 10.1002/mds.27135] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 12/31/2022] Open
Abstract
Although other nonmotor phenomena representing possible prodromal symptoms of Parkinson's disease have been described in some detail, the occurrence and characteristics of cognitive decline in this early phase of the disease are less well understood. The aim of this review is to summarize the current state of research on cognitive changes in prodromal PD. Only a small number of longitudinal studies have been conducted that examined cognitive function in individuals with a subsequent PD diagnosis. However, when we consider data from at-risk groups, the evidence suggests that cognitive decline may occur in a substantial number of individuals who have the potential for developing PD. In terms of specific cognitive domains, executive function in particular and, less frequently, memory scores are reduced. Prospective longitudinal studies are thus needed to clarify whether cognitive, and specifically executive, decline might be added to the prodromal nonmotor symptom complex that may precede motor manifestations of PD by years and may help to update the risk scores used for early identification of PD. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sophie Fengler
- Department of Medical Psychology ǀ Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Cologne, Germany.,Psychological Gerontology, Institute of Gerontology, University of Vechta, Vechta, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Eva Schäffer
- Department of Neurology, Christian-Albrechts-University, Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Kiel, Germany
| | - Elke Kalbe
- Department of Medical Psychology ǀ Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Cologne, Germany.,Psychological Gerontology, Institute of Gerontology, University of Vechta, Vechta, Germany
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6
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Yousaf T, Wilson H, Politis M. Imaging the Nonmotor Symptoms in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:179-257. [PMID: 28802921 DOI: 10.1016/bs.irn.2017.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Parkinson's disease is acknowledged to be a multisystem syndrome, manifesting as a result of multineuropeptide dysfunction, including dopaminergic, cholinergic, serotonergic, and noradrenergic deficits. This multisystem disorder ultimately leads to the presentation of a range of nonmotor symptoms, now appreciated to be an integral part of the disease-specific spectrum of symptoms, often preceding the diagnosis of motor Parkinson's disease. In this chapter, we review the dopaminergic and nondopaminergic basis of these symptoms by exploring the neuroimaging evidence based on several techniques including positron emission tomography, single-photon emission computed tomography molecular imaging, magnetic resonance imaging, functional magnetic resonance imaging, and diffusion tensor imaging. We discuss the role of these neuroimaging techniques in elucidating the underlying pathophysiology of NMS in Parkinson's disease.
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Affiliation(s)
- Tayyabah Yousaf
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Heather Wilson
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Marios Politis
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom.
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7
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Qamar MA, Sauerbier A, Politis M, Carr H, Loehrer PA, Chaudhuri KR. Presynaptic dopaminergic terminal imaging and non-motor symptoms assessment of Parkinson's disease: evidence for dopaminergic basis? NPJ Parkinsons Dis 2017; 3:5. [PMID: 28649605 PMCID: PMC5445592 DOI: 10.1038/s41531-016-0006-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/04/2016] [Accepted: 11/25/2016] [Indexed: 02/08/2023] Open
Abstract
Parkinson's disease (PD) is now considered to be a multisystemic disorder consequent on multineuropeptide dysfunction including dopaminergic, serotonergic, cholinergic, and noradrenergic systems. This multipeptide dysfunction leads to expression of a range of non-motor symptoms now known to be integral to the concept of PD and preceding the diagnosis of motor PD. Some non-motor symptoms in PD may have a dopaminergic basis and in this review, we investigate the evidence for this based on imaging techniques using dopamine-based radioligands. To discuss non-motor symptoms we follow the classification as outlined by the validated PD non-motor symptoms scale.
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Affiliation(s)
- MA Qamar
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - A Sauerbier
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - M Politis
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - H Carr
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - P A Loehrer
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - K Ray Chaudhuri
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
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8
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Pausch C, Schomburg R, Wagenpfeil S, Wollenweber FA, Bayer C, Fassbender K, Behnke S. Neuropsychological impairment in prodromal Parkinson's disease. J Neurol Sci 2016; 371:117-120. [PMID: 27871431 DOI: 10.1016/j.jns.2016.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 10/03/2016] [Accepted: 10/06/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Christoph Pausch
- Department of Neurology, Saarland University Hospital, Kirrberger Str., 66421 Homburg/Saar, Germany
| | - Robert Schomburg
- Department of Neurology, Saarland University Hospital, Kirrberger Str., 66421 Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Kirrberger Str. 100, 66421 Homburg/Saar, Germany
| | - Frank Arne Wollenweber
- Department of Neurology, Saarland University Hospital, Kirrberger Str., 66421 Homburg/Saar, Germany
| | - Caroline Bayer
- Department of Neurology, Saarland University Hospital, Kirrberger Str., 66421 Homburg/Saar, Germany
| | - Klaus Fassbender
- Department of Neurology, Saarland University Hospital, Kirrberger Str., 66421 Homburg/Saar, Germany
| | - Stefanie Behnke
- Department of Neurology, Saarland University Hospital, Kirrberger Str., 66421 Homburg/Saar, Germany.
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Zou J, Weng RH, Chen ZY, Wei XB, Wang R, Chen D, Xia Y, Wang Q. Position Emission Tomography/Single-Photon Emission Tomography Neuroimaging for Detection of Premotor Parkinson's Disease. CNS Neurosci Ther 2016; 22:167-77. [PMID: 26776081 DOI: 10.1111/cns.12493] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 11/12/2015] [Accepted: 11/14/2015] [Indexed: 12/21/2022] Open
Abstract
Premotor Parkinson's disease (PD) refers to a prodromal stage of Parkinson's disease (PD) during which nonmotor clinical features may be present. Currently, it is difficult to make an early diagnosis for premotor PD. Molecular imaging with position emission tomography (PET) or single-photon emission tomography (SPECT) offers a wide variety of tools for overcoming this difficulty. Indeed, molecular imaging techniques may play a crucial role in diagnosing, monitoring and evaluating the individuals with the risk for PD. For example, dopaminergic dysfunctions can be identified by detecting the expression of vesicular monoamine transporter (VMAT2) and aromatic amino acid decarboxylase (AADC) to evaluate the conditions of dopaminergic terminals functions in high-risk individuals of PD. This detection provides a sensitive and specific measurement of nonmotor symptoms (NMS) such as olfactory dysfunction, sleep disorders, and psychiatric symptoms in the high-risk patients, especially at the premotor phase. Molecular imaging technique is capable of detecting the dysfunction of serotonergic, noradrenergic, and cholinergic systems that are typically associated with premotor manifestations. This review discusses the importance of SPECT/PET applications in the detection of premotor markers preceding motor abnormalities with highlighting their great potential for early and accurate diagnosis of premotor symptoms of PD and its scientific significance.
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Affiliation(s)
- Jing Zou
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Rui-Hui Weng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhao-Yu Chen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiao-Bo Wei
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Rui Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Dan Chen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ying Xia
- Department of Neurosurgery, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Qing Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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Garcia-Rill E, Luster B, D’Onofrio S, Mahaffey S, Bisagno V, Urbano FJ. Pedunculopontine arousal system physiology - Deep brain stimulation (DBS). Sleep Sci 2015; 8:153-61. [PMID: 26779322 PMCID: PMC4688589 DOI: 10.1016/j.slsci.2015.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/03/2015] [Accepted: 09/05/2015] [Indexed: 12/19/2022] Open
Abstract
This review describes the wake/sleep symptoms present in Parkinson׳s disease, and the role of the pedunculopontine nucleus in these symptoms. The physiology of PPN cells is important not only because it is a major element of the reticular activating system, but also because it is a novel target for deep brain stimulation in the treatment of gait and postural deficits in Parkinson׳s disease. A greater understanding of the physiology of the target nuclei within the brainstem and basal ganglia, amassed over the past decades, has enabled increasingly better patient outcomes from deep brain stimulation for movement disorders.
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Key Words
- Basal forebrain
- Calcium channels
- DBS, deep brain stimulation
- EEG, electroencephalogram
- Gamma band activity
- LC, locus coeruleus
- Lateral hypothalamus
- Orexin
- PD, Parkinson׳s disease
- PGO, ponto-geniculo-occipital
- PPN, pedunculopontine nucleus
- RAS, reticular activating system
- REM, rapid eye movement
- SN, substantia nigra
- STN, subthalamic nucleus
- SubCD, subcoeruleus nucleus dorsalis
- Tuberomammillary
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Affiliation(s)
- Edgar Garcia-Rill
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Brennon Luster
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stasia D’Onofrio
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Susan Mahaffey
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Veronica Bisagno
- IFIBYNE-CONICET and ININFA-CONICET, University of Buenos Aires, Argentina
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Pellecchia MT, Picillo M, Santangelo G, Longo K, Moccia M, Erro R, Amboni M, Vitale C, Vicidomini C, Salvatore M, Barone P, Pappatà S. Cognitive performances and DAT imaging in early Parkinson's disease with mild cognitive impairment: a preliminary study. Acta Neurol Scand 2015; 131:275-81. [PMID: 25644029 DOI: 10.1111/ane.12365] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Mild cognitive impairment (MCI) is a common feature in Parkinson's disease (PD). We performed an exploratory study to investigate dopaminergic nigrostriatal innervation and its cognitive correlates in early untreated PD patients with MCI as compared to cognitively intact patients. PATIENTS AND METHODS A consecutive series of 34-de-novo, drug-naïve patients with PD were enrolled. They underwent [123-I] FP-CIT SPECT and comprehensive neuropsychological battery. MCI was identified in 15 of 34 patients with PD. RESULTS The two groups did not show any statistically significant difference in age, sex, disease duration, education, lateralization, and H&Y and Hospital Anxiety and Depression Scale scores. Logistic regression analysis showed that UPDRS-III was weakly associated with MCI (P = 0.034). Partial correlation analysis controlling for UPDRS-III and age suggested that in PD patients with MCI reduced V3″ values in the more affected caudate were correlated with reduced performances in frontal assessment battery, Trail Making Test: part B minus Part A and copy task of the Rey-Osterrieth complex figure test. Reduced V3″ values in the more and less affected putamen were significantly related with reduced performance in frontal assessment battery and in copy task of Rey-Osterrieth complex figure test, respectively. No correlation was found between neuropsychological scores and DAT availability in PD patients without MCI. CONCLUSIONS Although preliminary, our results suggest that striatal dopamine depletion may contribute to some cognitive deficit in early never treated PD patients with MCI.
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Affiliation(s)
- M. T. Pellecchia
- Center for Neurodegenerative Diseases; University of Salerno; Salerno Italy
| | - M. Picillo
- Department of Neurological Sciences; University Federico II; Naples Italy
| | - G. Santangelo
- Department of Psychology; Neuropsychology Laboratory; Second University of Naples; Caserta Italy
- IDC Hermitage-Capodimonte; Naples Italy
| | - K. Longo
- IDC Hermitage-Capodimonte; Naples Italy
| | - M. Moccia
- Department of Neurological Sciences; University Federico II; Naples Italy
| | - R. Erro
- Department of Neurological Sciences; University Federico II; Naples Italy
| | - M. Amboni
- IDC Hermitage-Capodimonte; Naples Italy
| | - C. Vitale
- IDC Hermitage-Capodimonte; Naples Italy
- University Parthenope; Naples Italy
| | - C. Vicidomini
- Institute of Biostructure and Bioimaging; CNR; Naples Italy
| | - M. Salvatore
- Department of Advanced Biomedical Sciences; University Federico II; Naples Italy
| | - P. Barone
- Department of Neurological Sciences; University Federico II; Naples Italy
| | - S. Pappatà
- Institute of Biostructure and Bioimaging; CNR; Naples Italy
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Brain (18)F-DOPA PET and cognition in de novo Parkinson's disease. Eur J Nucl Med Mol Imaging 2015; 42:1062-70. [PMID: 25820675 DOI: 10.1007/s00259-015-3039-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/05/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE The role of mesocortical dopaminergic pathways in the cognitive function of patients with early Parkinson's disease (PD) needs to be further clarified. METHODS The study groups comprised 15 drug-naive patients with de novo PD and 10 patients with essential tremor (controls) who underwent (18)F-DOPA PET (static acquisition, normalization on mean cerebellar counts) and an extended neuropsychological test battery. Factor analysis with varimax rotation was applied to the neuropsychological test scores, to yield five factors from 16 original scores, which explained 82 % of the total variance. Correlations between cognitive factors and (18)F-DOPA uptake were assessed with SPM8, taking age and gender as nuisance variables. RESULTS (18)F-DOPA uptake was significantly lower in PD patients than in controls in the bilateral striatum, mainly in the more affected (right) hemisphere, and in a small right temporal region. Significant positive correlations were found only in PD patients between the executive factor and (18)F-DOPA uptake in the bilateral anterior cingulate cortex (ACC) and the middle frontal gyrus, between the verbal fluency factor and (18)F-DOPA uptake in left BA 46 and the bilateral striatum, and between the visuospatial factor and (18)F-DOPA uptake in the left ACC and bilateral striatum. No correlations were found between (18)F-DOPA uptake and either the verbal memory factor or the abstraction-working memory factor. CONCLUSION These data clarify the role of the mesocortical dopaminergic pathways in cognitive function in early PD, highlighting the medial frontal lobe, anterior cingulate, and left BA 46 as the main sites of cortical correlation with executive and language functions.
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[Early recognition of Parkinson's disease. Objectifiable non-motor symptoms and biomarkers]. DER NERVENARZT 2014; 84:918-26. [PMID: 23831930 DOI: 10.1007/s00115-013-3756-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The clinical diagnosis of Parkinson's disease (PD) according to the UK Brain Bank criteria is based on the presence of motor symptoms and the response to dopaminergic medication. According to these criteria the clinical diagnosis is delineated too late when more than 50 % of the dopaminergic neurons are already degenerated. In recent years interest has shifted increasingly more towards non-motor symptoms (NMS), such as rapid eye movement (REM) sleep behavior disorder (RBD), constipation, hyposmia and neuropsychiatric as well as cognitive symptoms. It was shown that NMS can precede the motor symptoms by some years and may thus possibly enable support of an earlier clinical diagnosis. Furthermore, cerebrospinal fluid or blood biomarkers as well as brain imaging techniques can objectively support an earlier diagnosis of PD. This article reviews important NMSs (e.g. RBD, hyposmia and neuropsychiatric/cognitive symptoms) as well as the current status on biomarkers and brain imaging in early (premotor) phases of PD and their relevance for the early diagnosis.
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Zhang J, Wei L, Hu X, Zhang Y, Zhou D, Li C, Wang X, Feng H, Yin X, Xie B, Wang J. Specific frequency band of amplitude low-frequency fluctuation predicts Parkinson's disease. Behav Brain Res 2013; 252:18-23. [PMID: 23727173 DOI: 10.1016/j.bbr.2013.05.039] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/17/2013] [Accepted: 05/22/2013] [Indexed: 02/08/2023]
Abstract
Resting-state functional magnetic resonance imaging (RS-fMRI) has been considered for development as a biomarker and analytical tool for evaluation of Parkinson's disease (PD). Here we utilized analysis of the amplitude low-frequency fluctuations (ALFF) to determine changes in intrinsic neural oscillations in 72 patients with PD. Two different frequency bands (slow-5: 0.01-0.027 Hz; slow-4: 0.027-0.073 Hz) were analyzed. In the slow-5 band, PD patients compared with controls had increased ALFF values mainly in the caudate and several temporal regions, as well as decreased ALFF values in the cerebellum and the parieto-temporo-occipital cortex. Additionally, in the slow-4 band, PD patients relative to controls exhibited reduced ALFF value in the thalamus, cerebellum, and several occipital regions. Together, our data demonstrate that PD patients have widespread abnormal intrinsic neural oscillations in the corticostriatal network in line with the pathophysiology of PD, and further suggest that the abnormalities are dependent on specific frequency bands. Thus, frequency domain analyses of resting state BOLD signals may provide a useful means to study the pathophysiology of PD and the physiology of the brain's dopaminergic pathways.
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Affiliation(s)
- Jiuquan Zhang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, PR China
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Swerdlow RH. Does mitochondrial DNA play a role in Parkinson's disease? A review of cybrid and other supportive evidence. Antioxid Redox Signal 2012; 16:950-64. [PMID: 21338319 PMCID: PMC3643260 DOI: 10.1089/ars.2011.3948] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
SIGNIFICANCE Mitochondria are currently believed to play an important role in the neurodysfunction and neurodegeneration that underlie Parkinson's disease (PD). RECENT ADVANCES While it increasingly appears that mitochondrial dysfunction in PD can have different causes, it has been proposed that mitochondrial DNA (mtDNA) may account for or drive mitochondrial dysfunction in the majority of the cases. If correct, the responsible mtDNA signatures could represent acquired mutations, inherited mutations, or population-distributed polymorphisms. CRITICAL ISSUES AND FUTURE DIRECTIONS This review discusses the case for mtDNA as a key mediator of PD, and especially focuses on data from studies of PD cytoplasmic hybrid (cybrid) cell lines.
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Affiliation(s)
- Russell H Swerdlow
- Departments of Neurology, Biochemistry and Molecular Biology, and Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas, USA.
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Abstract
Parkinson's disease (PD) has a prodromal phase during which nonmotor clinical features as well as physiological abnormalities may be present. These premotor markers could be used to screen for PD before motor abnormalities are present. The technology to identify PD before it reaches symptomatic Braak Stage 3 (substantia nigra compacta [SNc] involvement) already exists. The current challenge is to define the appropriate scope of use of predictive testing for PD. Imaging technologies such as dopamine transporter imaging currently offer the highest degree of accuracy for identifying premotor PD, but they are expensive as screening tools, and abnormalities on these studies would only be evident at Braak Stage 3 or higher. Efficiency is greatly enhanced by combining imaging with a prescreening test such as olfactory testing. This 2-step process has the potential to greatly reduce costs while retaining diagnostic accuracy. Alternatively, or in concert with this approach, evaluating high-risk populations (eg, patients with rapid eye movement behavior disorder or LRRK2 mutations) would enrich the sample for cases with underlying PD. Ultimately, the role of preclinical detection of PD will be determined by the ability of emerging therapies to influence clinical outcomes. As such, implementation of large-scale screening strategies awaits the arrival of clearly safe and effective therapies that address the underlying pathogenesis of PD. Future research will establish more definitive biomarkers capable of revealing the presence of disease in advance of SNc involvement with the promise of the potential for introducing disease-modifying therapy even before the development of evidence of dopamine deficiency.
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Affiliation(s)
- Andrew Siderowf
- Parkinson's Disease and Mov Disord. Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Wirdefeldt K, Adami HO, Cole P, Trichopoulos D, Mandel J. Epidemiology and etiology of Parkinson's disease: a review of the evidence. Eur J Epidemiol 2011; 26 Suppl 1:S1-58. [PMID: 21626386 DOI: 10.1007/s10654-011-9581-6] [Citation(s) in RCA: 724] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 04/05/2011] [Indexed: 12/14/2022]
Abstract
The etiology of Parkinson's disease (PD) is not well understood but likely to involve both genetic and environmental factors. Incidence and prevalence estimates vary to a large extent-at least partly due to methodological differences between studies-but are consistently higher in men than in women. Several genes that cause familial as well as sporadic PD have been identified and familial aggregation studies support a genetic component. Despite a vast literature on lifestyle and environmental possible risk or protection factors, consistent findings are few. There is compelling evidence for protective effects of smoking and coffee, but the biologic mechanisms for these possibly causal relations are poorly understood. Uric acid also seems to be associated with lower PD risk. Evidence that one or several pesticides increase PD risk is suggestive but further research is needed to identify specific compounds that may play a causal role. Evidence is limited on the role of metals, other chemicals and magnetic fields. Important methodological limitations include crude classification of exposure, low frequency and intensity of exposure, inadequate sample size, potential for confounding, retrospective study designs and lack of consistent diagnostic criteria for PD. Studies that assessed possible shared etiological components between PD and other diseases show that REM sleep behavior disorder and mental illness increase PD risk and that PD patients have lower cancer risk, but methodological concerns exist. Future epidemiologic studies of PD should be large, include detailed quantifications of exposure, and collect information on environmental exposures as well as genetic polymorphisms.
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Affiliation(s)
- Karin Wirdefeldt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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18
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Comparison of dopamine turnover, dopamine influx constant and activity ratio of striatum and occipital brain with 18F-dopa brain PET in normal controls and patients with Parkinson’s disease. Eur J Nucl Med Mol Imaging 2011; 38:1550-9. [DOI: 10.1007/s00259-011-1819-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 04/06/2011] [Indexed: 11/25/2022]
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Ystad M, Eichele T, Lundervold AJ, Lundervold A. Subcortical functional connectivity and verbal episodic memory in healthy elderly—A resting state fMRI study. Neuroimage 2010; 52:379-88. [PMID: 20350608 DOI: 10.1016/j.neuroimage.2010.03.062] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 03/10/2010] [Accepted: 03/22/2010] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martin Ystad
- Department of Biomedicine, Neuroinformatics and Image Analysis Laboratory, University of Bergen, Bergen, Norway.
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Berendse HW, Ponsen MM. Diagnosing premotor Parkinson's disease using a two-step approach combining olfactory testing and DAT SPECT imaging. Parkinsonism Relat Disord 2010; 15 Suppl 3:S26-30. [PMID: 20083001 DOI: 10.1016/s1353-8020(09)70774-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Extranigral neuropathological changes may precede the degeneration of nigrostriatal dopaminergic neurones in Parkinson's disease (PD). Therefore, non-motor disturbances are an interesting target for the development of tests aimed at identifying individuals with premotor PD. An impaired sense of smell occurs with high prevalence in the clinical motor stages of PD patients and has also been reported in first-degree relatives of PD patients. In a prospective study in 361 asymptomatic first-degree relatives of PD patients, we studied the value of a two-step approach, combining olfactory testing and dopamine transporter (DAT) SPECT imaging, in detecting patients in the premotor phase of PD. Unexplained hyposmia alone was associated with a 12.5% risk of developing PD within a five year period. Cox regression analysis revealed that odour discrimination performance was most strongly correlated with the risk of future PD. Furthermore, all relatives that later developed PD had both hyposmia and abnormally reduced striatal DAT binding at baseline. The results of our studies provide the proof-of-principle that a two-step approach of olfactory testing and DAT SPECT imaging may serve to diagnose PD in its premotor phase. Yet, the low positive predictive value of hyposmia indicates that a wider application of this approach for screening purposes would require too many DAT SPECT scans in healthy individuals. Therefore, future studies in larger populations are necessary to further characterize premotor PD and identify additional genetic and/or clinical susceptibility markers to be used in conjunction with olfactory testing as additional screening steps toward diagnosing PD in its earliest stages.
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Affiliation(s)
- Henk W Berendse
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
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21
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Nobili F, Campus C, Arnaldi D, De Carli F, Cabassi G, Brugnolo A, Dessi B, Morbelli S, Sambuceti G, Abbruzzese G, Rodriguez G. Cognitive-nigrostriatal relationships in de novo, drug-naïve Parkinson's disease patients: A [I-123]FP-CIT SPECT study. Mov Disord 2010; 25:35-43. [DOI: 10.1002/mds.22899] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Behnke S, Schröder U, Berg D. Transcranial Sonography in the Premotor Diagnosis of Parkinson’s Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2010; 90:93-106. [DOI: 10.1016/s0074-7742(10)90007-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Stephenson R, Siderowf A, Stern MB. Premotor Parkinson's disease: Clinical features and detection strategies. Mov Disord 2009; 24 Suppl 2:S665-70. [DOI: 10.1002/mds.22403] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Multiple step pattern as a biomarker in Parkinson disease. Parkinsonism Relat Disord 2009; 15:506-10. [PMID: 19211293 DOI: 10.1016/j.parkreldis.2009.01.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 12/28/2008] [Accepted: 01/03/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate quantitative measures of saccades as possible biomarkers in early stages of Parkinson disease (PD) and in a population at-risk for PD. METHODS The study sample (n=68) included mildly to moderately affected PD patients, their unaffected siblings, and control individuals. All participants completed a clinical evaluation by a movement disorder neurologist. Genotyping of the G2019S mutation in the LRRK2 gene was performed in the PD patients and their unaffected siblings. A high resolution, video-based eye tracking system was employed to record eye positions during a battery of visually guided, anti-saccadic (AS), and two memory-guided (MG) tasks. Saccade measures (latency, velocity, gain, error rate, and multiple step pattern) were quantified. RESULTS PD patients and a subgroup of their unaffected siblings had an abnormally high incidence of multiple step patterns (MSP) and reduced gain of saccades as compared with controls. The abnormalities were most pronounced in the more challenging version of the MG task. For this task, the MSP measure demonstrated good sensitivity (87%) and excellent specificity (96%) in the ability to discriminate PD patients from controls. PD patients and their siblings also made more errors in the AS task. CONCLUSIONS Abnormalities in eye movement measures appear to be sensitive and specific measures in PD patients as well as a subset of those at-risk for PD. The inclusion of quantitative laboratory testing of saccadic movements may increase the sensitivity of the neurological examination to identify individuals who are at greater risk for PD.
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Siderowf A, Stern MB. Premotor Parkinson's disease: clinical features, detection, and prospects for treatment. Ann Neurol 2009; 64 Suppl 2:S139-47. [PMID: 19127581 DOI: 10.1002/ana.21462] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The period immediately before the onset of motor symptoms of Parkinson's disease (PD) often has a recognizable phenotype with features including autonomic dysfunction and impaired olfaction. Subclinical dopaminergic cell loss can also be detected at this time using molecular imaging techniques. A greater recognition of the features of premotor PD and improvements in screening technologies have opened the possibility of predictive testing for PD. In addition to molecular imaging of the dopamine system, screening tests that can potentially be used to identify the physiological abnormalities in premotor PD include olfactory testing, imaging of the sympathetic innervation of the heart, transcranial ultrasound, and genetic testing for mutations known to cause hereditary PD. All of these technologies have trade-offs as screening tests for accuracy, availability, and costs. Using these tests in combination may produce a more favorable combination of reasonable cost and accuracy than using any single test alone. Ultimately, the value of screening for PD depends on development of neuroprotective treatments for PD that would create an imperative for early identification and treatment.
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Affiliation(s)
- Andrew Siderowf
- Parker Family Professor of Neurology Director, Parkinson's Disease and Movement Disorder Center, University of Pennsylvania, USA.
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26
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Jokinen P, Brück A, Aalto S, Forsback S, Parkkola R, Rinne JO. Impaired cognitive performance in Parkinson's disease is related to caudate dopaminergic hypofunction and hippocampal atrophy. Parkinsonism Relat Disord 2009; 15:88-93. [DOI: 10.1016/j.parkreldis.2008.03.005] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 03/09/2008] [Accepted: 03/11/2008] [Indexed: 10/22/2022]
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Liepelt I, Wendt A, Schweitzer KJ, Wolf B, Godau J, Gaenslen A, Bruessel T, Berg D. Substantia nigra hyperechogenicity assessed by transcranial sonography is related to neuropsychological impairment in the elderly population. J Neural Transm (Vienna) 2008; 115:993-9. [PMID: 18368284 DOI: 10.1007/s00702-008-0043-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 03/09/2008] [Indexed: 11/25/2022]
Abstract
Transcranial sonography (TCS) is a valuable tool in the diagnosis of Parkinson's disease (PD). However, substantia nigra hyperechogenicity (SN+) in TCS has been shown to be also evident in about 8-10% of healthy persons. Neuroimaging studies and slight motor deficits in subjects with SN+ indicate functional impairment of the nigrostriatal system associated with the ultrasound sign. We questioned, whether SN+ may also be associated with neuropsychological deficits and whether there is a relation to other PD premotor markers. Thirty-six subjects with SN+ and 34 control persons (SN-) older than 50 years were investigated. The delayed verbal memory recall (LogII) of subjects with SN+ was significantly reduced compared to the performance of the control group (P=0.02). Binary logistic regression analysis revealed that, besides UPDRS-III (P<0.001) and positive family history for PD (P<0.01), LogII (P<0.05) seems to be independently associated with SN+.
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Affiliation(s)
- Inga Liepelt
- Center of Neurology, Department of Neurodegeneration, Hertie Institute of Clinical Brain Research, University of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany.
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Pellicano C, Benincasa D, Pisani V, Buttarelli FR, Giovannelli M, Pontieri FE. Prodromal non-motor symptoms of Parkinson's disease. Neuropsychiatr Dis Treat 2007; 3:145-52. [PMID: 19300544 PMCID: PMC2654529 DOI: 10.2147/nedt.2007.3.1.145] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The motor symptoms of Parkinson's disease (PD), bradykinesia, muscular rigidity, and tremor depend upon degeneration of the dopaminergic neurons in the substantia nigra pars compacta. Recent neuropathological studies show that the Lewy bodies, the intraneuronal landmark of PD, accumulate in several neuronal cell types in the brain. An ascending gradient of pathological involvement, from the medulla oblongata to neocortical areas has been reported. Thus the original view of PD as a disease characterized by selective damage of the dopaminergic neurons in the mesencephalon should be updated into the concept of a severe multisystemic neurodegenerative disorder. Additionally, the neuropathological alterations outside the substantia nigra are soundly correlated with the non-motor symptoms of PD. As a result of these findings, interest is growing in the identification of prodromal non-motor symptoms of PD. Indeed, data from the literature suggest that autonomic disturbances, olfactory dysfunctions, depression and sleep disorders (in particular REM-sleep behavior disorder) may represent prodromal non-motor symptoms of PD. Several tests are available to detect most of these symptoms. Thus, the identification of prodromal non-motor symptoms may contribute to the precocious diagnosis of PD, and might be useful in the future to test the efficacy of neuroprotective agents.
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Affiliation(s)
- Clelia Pellicano
- Dipartimento di Scienze, Neurologiche, II Facoltà di Medicina e Chirurgia; Università degli Studi di Roma "La Sapienza", Italy
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Cropley VL, Fujita M, Innis RB, Nathan PJ. Molecular imaging of the dopaminergic system and its association with human cognitive function. Biol Psychiatry 2006; 59:898-907. [PMID: 16682268 DOI: 10.1016/j.biopsych.2006.03.004] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Revised: 10/07/2005] [Accepted: 03/06/2006] [Indexed: 11/16/2022]
Abstract
Molecular imaging with positron emission tomography (PET) and single photon emission computed tomography (SPECT) has recently been used to examine dopamine (DA) function and its relationship with cognition in human subjects. This article will review PET and SPECT studies that have explored the relationship between cognitive processes and components of the DA system (pre-, intra-, and postsynaptic) in healthy and patient populations such as Parkinson's disease (PD), schizophrenia, Huntington's disease, and aging. It is demonstrated that DA activity modulates a range of frontal executive-type cognitive processes such as working memory, attentional functioning, and sequential organization, and alterations of DA within the fronto-striato-thalamic circuits might contribute to the cognitive impairments observed in PD, schizophrenia, and normal aging. Although associations between DA and cognitive measures need to be considered within the context of fronto-striato-thalamic circuitry, it is suggested that striatal (especially caudate) DA activity, particularly via D2 receptors, might be important for response inhibition, temporal organization of material, and motor performance, whereas cortical DA transmission via D1 receptors might be important for maintaining and representing on-going behavior.
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Affiliation(s)
- Vanessa L Cropley
- Department of Physiology, Behavioural Neuroscience Laboratory, Monash Centre for Brain and Behaviour, Monash University, Victoria, Australia.
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Bäckman L, Nyberg L, Lindenberger U, Li SC, Farde L. The correlative triad among aging, dopamine, and cognition: Current status and future prospects. Neurosci Biobehav Rev 2006; 30:791-807. [PMID: 16901542 DOI: 10.1016/j.neubiorev.2006.06.005] [Citation(s) in RCA: 511] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The brain neuronal systems defined by the neurotransmitter dopamine (DA) have since long a recognized role in the regulation of motor functions. More recently, converging evidence from patient studies, animal research, pharmacological intervention, and molecular genetics indicates that DA is critically implicated also in higher-order cognitive functioning. Many cognitive functions and multiple markers of striatal and extrastriatal DA systems decline across adulthood and aging. Research examining the correlative triad among adult age, DA, and cognition has found strong support for the view that age-related DA losses are associated with age-related cognitive deficits. Future research strategies for examining the DA-cognitive aging link include assessing (a) the generality/specificity of the effects; (b) the relationship between neuromodulation and functional brain activation; and (c) the release of DA during actual task performance.
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Affiliation(s)
- Lars Bäckman
- Aging Research Center, Division of Geriatric Epidemiology, Neurotec, Karolinska Institute, Box 6401, S 113 82 Stockholm, Sweden.
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Berg D. Marker for a preclinical diagnosis of Parkinson's disease as a basis for neuroprotection. JOURNAL OF NEURAL TRANSMISSION. SUPPLEMENTUM 2006:123-32. [PMID: 17447423 DOI: 10.1007/978-3-211-33328-0_14] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Neuroprotective therapy is a pivotal aim in the treatment of the relentlessly progressive disorder Parkinson's disease. However, more than 60% of the dopaminergic neurons of the substantia nigra have already degenerated, when the diagnosis may be established. At this "advanced stage" neuroprotective strategies will - if at all - only have limited effect. It is, therefore, essential to establish markers to identify subjects at risk before motor manifestation. A number of such "premotor" signs have been discovered and investigated lately. Such signs include a genetic vulnerability and hyperechogenicity of the substantia nigra as well as premotor symptoms like olfactory and autonomic dysfunction, depression, REM sleep behaviour disorder, visual and neuropsychological impairment. Moreover, first signs of affection of the substantia nigra like PET and SPECT abnormalities and slight motor signs can be included, as they may be detected before a definite diagnosis can be made. Although most of these signs and symptoms are unspecific if singularly evaluated a combination of these features may indeed be valuable to detect a subgroup of the population at risk for PD. However, future studies are necessary to establish the predictive value of these "markers" singularly and in combination.
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Affiliation(s)
- Daniela Berg
- Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany.
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Nagano-Saito A, Kato T, Arahata Y, Washimi Y, Nakamura A, Abe Y, Yamada T, Iwai K, Hatano K, Kawasumi Y, Kachi T, Dagher A, Ito K. Cognitive- and motor-related regions in Parkinson's disease: FDOPA and FDG PET studies. Neuroimage 2004; 22:553-61. [PMID: 15193583 DOI: 10.1016/j.neuroimage.2004.01.030] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2003] [Revised: 12/18/2003] [Accepted: 01/16/2004] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Using 6-[(18)F]fluoro-L-dopa (FDOPA) and [(18)F]fluorodeoxyglucoce (FDG) positron emission tomography (PET), multiple regression analyses were performed to determine the specific brain regions that are related to cognitive and motor symptoms in nondemented patients with Parkinson's disease. METHODS Spatially normalized images of FDOPA influx rate constant (Ki) values and relative regional cerebral metabolic rates for glucose (rrCMRglc) were created. Raven's Coloured Progressive Matrices (RCPM) scores and the Unified Parkinson's Disease Rating Scale (UPDRS) motor scores were used to determine the patients' cognitive and motor functions, respectively. Multiple correlation analyses between the FDOPA and FDG images and the cognitive and motor scores were performed for each voxel. RESULTS RCPM score was significantly positively correlated with the FDOPA Ki in the left hippocampus and with the rrCMRglc in the left middle frontal gyrus and right retrosplenial cortex. Motor function was significantly positively correlated with the FDOPA Ki in the bilateral striatum and with the rrCMRglc in association areas and primary visual cortex. The level of motor function was significantly inversely correlated with the FDOPA Ki in the anterior cingulate gyrus and with the rrCMRglc in bilateral primary motor cortex and right putamen. CONCLUSIONS Changes of striatal FDOPA uptake and rrCMRglc in the primary motor cortex likely represent dysfunction in the motor system involving the corticobasal ganglia-thalamocortical loop. Change of FDOPA uptake in the anterior cingulate gyrus may be related to up-regulation of dopamine synthesis in surviving dopamine neurons. The regions where correlation with cognitive function was observed belong to a cognitive frontoparietal-hippocampal network.
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Affiliation(s)
- Atsuko Nagano-Saito
- Department of Biofunctional Research, National Institute for Longevity Sciences, Obu, Japan.
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Heiss WD, Hilker R. The sensitivity of 18-fluorodopa positron emission tomography and magnetic resonance imaging in Parkinson's disease. Eur J Neurol 2004; 11:5-12. [PMID: 14692881 DOI: 10.1046/j.1351-5101.2003.00709.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Parkinson's disease (PD) as the most important movement disorder is characterized by a progressive loss of nigral dopamine neurons and a subsequent degeneration within several other transmitter systems. Functional brain imaging with positron emission tomography (PET) and the radiotracer 18-fluorodopa (FDOPA) is capable to quantify the deficiency of dopamine synthesis and storage within pre-synaptic striatal nerve terminals. Therefore, FDOPA-PET allows the diagnosis of PD in early disease stages and the differentiation of clinically unclear cases from other movement disorders, e.g. essential tremor. Additionally, FDOPA-PET imaging permits the follow-up of disease progression, the assessment of medical and surgical PD therapy strategies with possible neuroprotective properties and the detection of pre-clinical disease in subjects at risk for the disorder. The classical domain of morphological magnetic resonance imaging (MRI) is the differentiation of symptomatic Parkinsonism from PD. However, recent advances in MRI data acquisition and analysis techniques demonstrated MRI to be also a valuable tool for detection of nigral pathology in PD and for differentiation of neurodegenerative disorders with atypical Parkinsonism.
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Affiliation(s)
- W-D Heiss
- Neurology Department, University Hospital, Cologne, Germany.
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Di Monte DA. The environment and Parkinson's disease: is the nigrostriatal system preferentially targeted by neurotoxins? Lancet Neurol 2003; 2:531-8. [PMID: 12941575 DOI: 10.1016/s1474-4422(03)00501-5] [Citation(s) in RCA: 260] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Recent epidemiological and experimental studies have renewed interest in the hypothesis that the environment has a role in the pathogenesis of Parkinson's disease (PD). Epidemiological studies have identified protective associations (eg, smoking) as well as adverse risk factors (eg, pesticide exposure) for PD. The concordance rate of PD in pairs of dizygotic twins is similar to that in pairs of monozygotic twins, supporting a role of non-genetic risk factors. New models of selective nigrostriatal damage--such as neurotoxicity induced by rotenone or paraquat--have emphasised that environmental agents may contribute to the neurodegenerative process in PD. Toxins interact, in vitro and in vivo, with alpha-synuclein, an endogenous protein that is implicated in pathology of PD. Similarities between clinical and experimental findings, such as the role of pesticide exposure as a potential environmental risk factor, highlight the importance of a multidisciplinary approach to the aetiology of PD.
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Abstract
PURPOSE OF REVIEW Cognitive deficits that occur even early in the course of Parkinson's disease have received increasing attention in current imaging research. The exact physio-pathological processes mediating the deficits and the complex relationship of cognitive signs and antiparkinsonian treatment are not well understood. A clearer understanding of these mechanisms could potentially influence treatment choices, drug development and, ultimately, patient care. RECENT FINDINGS Abnormal networks identified in studies of resting state metabolism in Parkinson's disease represent metabolic markers for remote effects of striato-nigral degeneration. These metabolic changes include subcortico-cortical networks, in particular cognitive cortico-striato-pallidal-thalamocortical loops. Recent brain studies focus on intervention-related brain changes. They illustrate different task-specific changes in brain activation with deep brain stimulation and with levodopa. Variable results of stimulation can be attributed to different effects on segregated cortico-striato-pallidal-thalamocortical loops during stimulation. By contrast, the heterogeneity observed in studies with levodopa possibly reflects the disease-stage and task-specific effects of levodopa. A decline in caudate dopamine modulated basal ganglia outflow appears to contribute to executive dysfunction and to brain activation changes in these loops at early Parkisnon's disease stages, while mesocortical degeneration mediated increases of inefficient dorsolateral prefrontal cortex activation may display a feature of more advanced disease stages only. SUMMARY Despite evidence for the role of dopamine and cortico-striato-pallidal-thalamocortical loops in cognition, the specific contributions of mesocortical dopamine depletion and striatal dysfunction with downstream consequences on the loops remain to be separated. Additionally, more research is needed into the role of non-dopaminergic pathology in cognitive decline in Parkinson's disease.
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Affiliation(s)
- Maren Carbon
- Center for Neurosciences, North Shore-Long Island Jewish Research Institute, New York, New York, USA
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Kaasinen V, Rinne JO. Functional imaging studies of dopamine system and cognition in normal aging and Parkinson's disease. Neurosci Biobehav Rev 2002; 26:785-93. [PMID: 12470690 DOI: 10.1016/s0149-7634(02)00065-9] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Modern functional imaging methods, such as positron emission tomography (PET) and single photon emission computed tomography (SPECT), provide non-invasive, quantitative tools for the direct measurement of neurotransmitter function in the living human brain. The dopamine system has been of key interest; first, because it has a prominant role in several cognitive and motor processes, and secondly because the tracers currently available for the dopamine system enable an effective investigation of various pre, post- and intra-synaptic processes. Recent functional imaging findings indicate that certain cognitive deficits associated with both normal aging and Parkinson's disease are modulated by changes in the brain dopamine system. This review covers the literature related to age-associated phenomena in the dopamine system studied with in vivo imaging. In particular, the focus is on describing and discussing the relationships between aging, cognition and the dopaminergic system in healthy subjects and in patients with Parkinson's disease.
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Affiliation(s)
- Valtteri Kaasinen
- Department of Neurology, University of Turku, PO Box 52, FIN-20521, Turku, Finland.
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Abstract
Parkinson's disease (PD) was noted to have a familial component as early as 1880 (Leroux, 1880). More recently, the discovery of several genetic factors influencing parkinsonism has emphasized the importance of heredity in PD. The clinical spectrum of familial parkinsonism is wide; it includes not only PD, but also dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP), essential tremor, and other disorders. In the general population, it is likely that PD results from combined genetic and environmental factors, most of which are not yet known. The discovery of causal mutations in the gene for alpha-synuclein, parkin, and of genetic linkages to chromosomes 2p4, 4p5, and three loci on 1q6-8 have revolutionized PD research. This review focuses on recent progress in the Mendelian genetics of PD and those diseases in which parkinsonism is a prominent feature, and considers how these discoveries modify our beliefs regarding the etiology and pathogenesis of these disorders.
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Affiliation(s)
- Katrina Gwinn-Hardy
- Division of Intramural Research, Neurogenetics Laboratories, National Institute of Neurological Disease and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Brück A, Portin R, Lindell A, Laihinen A, Bergman J, Haaparanta M, Solin O, Rinne JO. Positron emission tomography shows that impaired frontal lobe functioning in Parkinson's disease is related to dopaminergic hypofunction in the caudate nucleus. Neurosci Lett 2001; 311:81-4. [PMID: 11567783 DOI: 10.1016/s0304-3940(01)02124-3] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We examined the relation between the dopaminergic function and the cognitive performance of patients with Parkinson's disease (PD). The subject sample consisted of ten patients in the early course of PD and with no previous antiparkinsonian medication. The dopaminergic function of the caudate nucleus and the putamen was studied with [(18)F]fluorodopa positron emission tomography, and the cognitive performance with a comprehensive battery of neuropsychological tests including tests sensitive to frontal lobe function. The decreased [(18)F]fluorodopa uptake in the right caudate nucleus was found to be related to slow processing time, measured as the difference between the incongruent and the congruent subtests of the Stroop Test (r=-0.85, P=0.002), a similar trend was seen in the left caudate (r=-0.60, P=0.07). Similar correlation was not detected in the putamen. The present findings provide evidence that the decreased dopaminergic function in the right caudate nucleus is related to the impaired performance in tests sensitive to frontal lobe function in patients at an early stage of PD and with no antiparkinsonian medication.
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Affiliation(s)
- A Brück
- Turku PET Centre, University of Turku, FIN-20520, Turku, Finland
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41
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Bednarczyk EM. Functional Imaging for the Monitoring of Clinical Outcomes of Pharmacotherapy. J Pharm Pract 2001. [DOI: 10.1106/t955-v189-ltap-38my] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Functional and anatomic imaging have been used almost exclusively for diagnostic purposes. Because pharmacotherapy is expected to alter organ function, functional imaging is ideally suited to assess drug effects. The application of functional imaging techniques for this purpose has recently emerged. This paper reviews application of radiopharmaceuticals and nuclear imaging techniques to the assessment of pharmacologic effects in neurology, psychiatry, cardiology, and oncology.
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Affiliation(s)
- Edward M. Bednarczyk
- University at Buffalo, School of Pharmacy and Pharmaceutical Science, Department of Pharmacy Practice, School of Medicine, Department of Nuclear Medicine, University at Buffalo-State University of New York, 105 Parker Hall, 3435 Main St., Buffalo, NY 14214-3007,
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Berendse HW, Booij J, Francot CM, Bergmans PL, Hijman R, Stoof JC, Wolters EC. Subclinical dopaminergic dysfunction in asymptomatic Parkinson's disease patients' relatives with a decreased sense of smell. Ann Neurol 2001; 50:34-41. [PMID: 11456307 DOI: 10.1002/ana.1049] [Citation(s) in RCA: 196] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
By the time a clinical diagnosis of Parkinson's disease (PD) is made, a significant loss of dopaminergic neurons has already occurred. Identifying patients in the period between the presumed onset of dopaminergic cell loss and the appearance of clinical parkinsonism may be of major importance in the development of effective neuroprotective treatment strategies. In an effort to develop a feasible strategy to detect preclinical PD, a combination of olfactory processing tasks, including odor detection, odor identification, and odor discrimination was used to select groups of hyposmic and normosmic individuals from a total of 250 relatives (parents, siblings, or children) of subjects with PD. Single photon emission computed tomography (SPECT) with [123I]beta-CIT as a dopamine transporter ligand was used to assess nigrostriatal dopaminergic function in 25 hyposmic and 23 normosmic relatives of PD patients. An abnormal reduction in striatal dopamine transporter binding was found in 4 out of 25 hyposmic relatives of PD patients, two of whom subsequently developed clinical parkinsonism, and in none of the 23 normosmic relatives. These observations demonstrate that subclinical reductions in dopamine transporter binding can be detected in asymptomatic relatives of sporadic PD patients by means of [123I]beta-CIT and SPECT. The results further indicate that olfactory deficits may precede clinical motor signs in PD.
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Affiliation(s)
- H W Berendse
- Department of Neurology, Research Institute Neurosciences, Vrije Universiteit, Amsterdam, The Netherlands.
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Hilker R, Klein C, Ghaemi M, Kis B, Strotmann T, Ozelius LJ, Lenz O, Vieregge P, Herholz K, Heiss WD, Pramstaller PP. Positron emission tomographic analysis of the nigrostriatal dopaminergic system in familial Parkinsonism associated with mutations in theParkin gene. Ann Neurol 2001. [DOI: 10.1002/ana.74] [Citation(s) in RCA: 156] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hattori N, Shimura H, Kubo S, Kitada T, Wang M, Asakawa S, Minashima S, Shimizu N, Suzuki T, Tanaka K, Mizuno Y. Autosomal recessive juvenile parkinsonism: a key to understanding nigral degeneration in sporadic Parkinson's disease. Neuropathology 2000; 20 Suppl:S85-90. [PMID: 11037196 DOI: 10.1046/j.1440-1789.2000.00312.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The contribution of genetic factors to the pathogenesis of Parkinson's disease (PD) is supported by the demonstration of the high concordance in twins studies using positron emission tomography (PET), the increased risk among relatives of PD patients in case-control and family studies, and the existence of familial PD and parkinsonism by single gene defect. Recently several genes have been mapped and/or identified. Alpha-synuclein is involved in a rare dominant form of familial PD with dopa-responsive parkinsonism features and Lewy body-positive pathology. In contrast, parkin is responsible for the autosomal recessive form (AR-JP) of early onset PD with Lewy body-negative pathology. The clinical features of this form include early onset (in the 20s), levodopa-responsive parkinsonism, diurnal fluctuation, and slow progression of the disease. Parkin consists of 12 exons and the estimated size is over 1.5 Mb. To date, variable mutations such as deletions or point mutations resulting in missense and nonsense changes have been reported in AR-JP patients. In addition, the localization of parkin indicates that parkin may be involved in the axonal transport system. More recently we have found that parkin interacts with the ubiquitin-conjugating enzyme E2 and is functionally linked to the Ub-proteasome pathway as a ubiquitin ligase, E3. These findings fit the characteristics of a lack of Lewy bodies (these are cytoplasmic inclusions that are considered to be a pathological hallmark). Our findings should enhance the exploration of the mechanisms of neuronal death in PD as well as other neurodegenerative disorders of which variable inclusion bodies are observed.
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Affiliation(s)
- N Hattori
- Department of Neurology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan.
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Zhang Y, Dawson VL, Dawson TM. Oxidative stress and genetics in the pathogenesis of Parkinson's disease. Neurobiol Dis 2000; 7:240-50. [PMID: 10964596 DOI: 10.1006/nbdi.2000.0319] [Citation(s) in RCA: 326] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Parkinson's Disease (PD) is the second most common chronic neurodegenerative disease characterized by the progressive loss of dopamine neurons, leading to rigidity, slowness of movement, rest tremor, gait disturbances, and imbalance. Although there is effective symptomatic treatment for PD, there is no proven preventative or regenerative therapy. The etiology of this disorder remains unknown. Recent genetic studies have identified mutations in alpha-synuclein as a rare cause of autosomal dominant familial PD and mutations in parkin as a cause of autosomal recessive familial PD. The more common sporadic form of PD is thought to be due to oxidative stress and derangements in mitochondrial complex I activity. Understanding the mechanism by which familial linked mutations and oxidative stress cause PD has tremendous potential for unraveling the mechanisms of dopamine cell death in PD. In this article, we review recent advances in the understanding of the role of genetics and oxidative stress in the pathogenesis of PD.
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Affiliation(s)
- Y Zhang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA
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46
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Gasser T. Autosomal-dominantly inherited forms of Parkinson's disease. JOURNAL OF NEURAL TRANSMISSION. SUPPLEMENTUM 2000:31-40. [PMID: 11128611 DOI: 10.1007/978-3-7091-6284-2_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Today, a genetic contribution to the etiology of Parkinson's disease (PD) is generally accepted, based on the demonstration of a familial aggregation of the disease, as demonstrated by several case-control and twin-studies. However, most cases of PD appear to be sporadic, and in the majority of those with a positive family history, no clear mendelian mode of inheritance can be established. Therefore, a polygenic mode of inheritance or a multifactorial etiology is likely in these cases. On the other hand, a number of families have been identified, in whom parkinsonism is inherited as an apparently monogenic mendelian trait with high penetrance. In several of these families, the disease genes have been mapped and mutations have been identified in some of them. The first gene locus has been mapped to the long arm of chromosome 4 in a small number of families with autosomal-dominant inheritance and typical Lewy-body pathology (PARK 1), and mutations have been identified in the gene for alpha-synuclein in these kindreds. Two other loci in families with dominant inheritance have been mapped, to chromosome 2p13 (PARK 3) and to chromosome 4p, respectively. A gene causing autosomal recessive parkinsonism of juvenile onset has been mapped to chromosome 6 (PARK 2), and the causative gene has been identified and named parkin. Each of these genetically defined familial disorders share clinical characteristics that fulfill the criteria accepted for idiopathic Parkinson's disease but, as in sporadic PD, also show a variability of clinical expressions, both within and between families. At present, there is no direct evidence that any of these genes for familial Parkinsonian syndromes have a direct role in the etiology of the common sporadic form of PD. However, the elucidation of the molecular sequence of events leading to nigral degeneration in these inherited cases is likely to shed light also on the molecular pathogenesis of the common sporadic form of this disorder.
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Affiliation(s)
- T Gasser
- Neurologische Klinik und Poliklinik, Klinikum Grosshadern, Ludwig-Maximilians-Universität, Munich, Federal Republic of Germany.
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Hattori N, Shimura H, Kubo S, Wang M, Shimizu N, Tanaka K, Mizuno Y. Importance of familial Parkinson's disease and parkinsonism to the understanding of nigral degeneration in sporadic Parkinson's disease. JOURNAL OF NEURAL TRANSMISSION. SUPPLEMENTUM 2000:101-16. [PMID: 11205133 DOI: 10.1007/978-3-7091-6301-6_6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
We review here familial Parkinson's disease (PD) from clinical as well as molecular genetic aspects. The contribution of genetic factors to the pathogenesis of PD is supported by the demonstration of the high concordance in twins, increased risk among relatives of PD patients in case control and family studies, and the existence of familial PD and parkinsonism based on single gene defects. Recently, several genes have been mapped and/or identified in patients with familial PD. Alpha-synuclein is involved in a rare dominant form of familial PD with dopa responsive parkinsonian features and Lewy body positive pathology. In contrast, parkin is responsible for autosomal recessive form of early-onset PD with Lewy body-negative pathology. This form is identified world-wide among patients with young-onset PD. Furthermore, ubiquitin carboxy terminal hydrolase L1 gene is responsible for an autosomal dominant form of typical PD, although only a single family has so far been identified with a mutation of this gene, and tau has been identified as a causative gene for frontotemporal dementia and parkinsonism. In addition, five other chromosome loci have been identified to be linked to familial PD or dystonia-parkinsonism. The presence of different loci or different causative genes indicates that PD is not a single entity but a highly heterogeneous. Identification and elucidation of the causative genes should enhance our understanding of the pathogenesis of sporadic PD.
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Affiliation(s)
- N Hattori
- Department of Neurology, Juntendo University School of Medicine, Bunkyo, Tokyo, Japan.
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Dujardin K, Duhamel A, Becquet E, Grunberg C, Defebvre L, Destee A. Neuropsychological abnormalities in first degree relatives of patients with familial Parkinson's disease. J Neurol Neurosurg Psychiatry 1999; 67:323-8. [PMID: 10449554 PMCID: PMC1736525 DOI: 10.1136/jnnp.67.3.323] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the cognitive profile of first degree relatives of patients with familial Parkinson's disease to determine whether these subjects presented signs of neuropsychological dysfunction compared with healthy controls. Results of recent genetic and neuroimaging studies suggest a genetic contribution to the aetiology of Parkinson's disease and underline the interest in identifying preclinical signs of the disease. METHODS A battery of tests evaluating executive function was administered to 41 first degree relatives of patients with well documented familial Parkinson's disease and 39 healthy controls. A factorial discriminant analysis allowed isolation of a subgroup of 15 first degree relatives who could be considered as impaired compared with the healthy controls. Among these 15 "deviant" relatives, nine performed globally worse than the control subjects on all tasks. The six other subjects had mean or even high scores on all task variables, except on those highly correlated with the discriminant score of the factorial discriminant analysis. RESULTS AND CONCLUSION Among the first degree relatives of patients with familial Parkinson's disease, some manifested executive dysfunction comparable with that typically associated with the disease. Such impairment could represent a preclinical form of Parkinson's disease.
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Affiliation(s)
- K Dujardin
- CHRU de Lille, Clinique Neurologique, Neurologie A, Hôpital R. Salengro, 59037 Lille Cedex, France.
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Marié RM, Barré L, Dupuy B, Viader F, Defer G, Baron JC. Relationships between striatal dopamine denervation and frontal executive tests in Parkinson's disease. Neurosci Lett 1999; 260:77-80. [PMID: 10025703 DOI: 10.1016/s0304-3940(98)00928-8] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Indirect evidence from human and monkey investigations supports the idea that impaired frontal tasks in Parkinson's disease (PD) may result from striato-frontal disruption caused by dopamine (DA) denervation of the caudate nucleus. To directly investigate this hypothesis, we used PET with 11C-S-Nomifensine (11C-S-NMF), a sensitive marker of striatal DA denervation, in 10 non-demented PD patients in whom two frontal executive tests, the object alternation (OA) and the conditional associative learning (CAL) tasks, thought to reflect mainly set-shifting/inhibition and planning, respectively, were given. In addition, the central executive function of verbal working memory was assessed with the Brown Peterson paradigm (BPP). We found a highly significant correlation between right caudate 11C-S-NMF specific binding and OA performance, less significant and reverse-direction correlations between CAL performance and putamen 11C-S-NMF binding, and no significant correlation with BPP performance. Thus, caudate DA denervation may subtend poor set-shifting/inhibition process in PD. Our results also point to distinct and complex relationships between striatal DA and specific frontal tasks.
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Affiliation(s)
- R M Marié
- INSERM U. 320, Cyceron, Services de Neurologie Vastel et Déjérine, CHU de Caen, France
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Charlett A, Dobbs RJ, Dobbs SM, Weller C, Brady P, Peterson DW. Parkinsonism: siblings share Helicobacter pylori seropositivity and facets of syndrome. Acta Neurol Scand 1999; 99:26-35. [PMID: 9925235 DOI: 10.1111/j.1600-0404.1999.tb00654.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Given a history of peptic ulcer is more frequent in parkinsonism, to investigate the role of Helicobacter pylori in its pathogenesis and of cross-infection in familial aggregation. METHODS Facets of parkinsonism were quantified in 33 elderly subjects with idiopathic parkinsonism and in their 39 siblings with double the number of controls, all obeying inclusion/exclusion criteria. Specific-IgG antibody was assayed. RESULTS Siblings, compared with controls, had brady/hypokinesia of gait (P< or =0.002), bradykinesia of hands (P = 0.01), abnormal posture (P = 0.001), rigidity (P < 0.001) and seborrhoea/seborrhoeic dermatitis (P = 0.02). Both parkinsonians and siblings differed from controls in the odds of being H. pylori seropositive [odds ratios 3.04 (95% C.I.: 1.22, 7.63) and 2.94 (1.26, 6.86) respectively, P < 0.02], seropositivity being found in 0.70 of sufferers. CONCLUSION Familial transmission of chronic infection plus part of syndrome links Helicobacter with causality. Seropositivity not being universal throughout parkinsonism, consequent on gastric atrophy +/- sporadic antibiotic exposure, might explain less aggressive disease in older sufferers.
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Affiliation(s)
- A Charlett
- Therapeutics in the Elderly, Research Group, The Hillingdon Hospital Postgraduate and Research Centre, Uxbridge, UK
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