1
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Kannenberg S, Caspers J, Dinkelbach L, Moldovan AS, Ferrea S, Südmeyer M, Butz M, Schnitzler A, Hartmann CJ. Investigating the 1-year decline in midbrain-to-pons ratio in the differential diagnosis of PSP and IPD. J Neurol 2020; 268:1526-1532. [PMID: 33277666 PMCID: PMC7990839 DOI: 10.1007/s00415-020-10327-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/10/2020] [Accepted: 11/19/2020] [Indexed: 11/03/2022]
Abstract
Background A reliable measure of PSP-specific midbrain atrophy, the midbrain-to-pons ratio (MTPR) has been reported to support the differential diagnosis of progressive supranuclear palsy (PSP) from idiopathic Parkinson’s disease (IPD). Since longitudinal analyses are lacking so far, the present study aimed to evaluate the diagnostic value of the relative change of MTPR (relΔt_MTPR) over a 1-year period in patients with PSP, IPD, and healthy controls (HC). Methods Midsagittal individual MRIs of patients with PSP (n = 15), IPD (n = 15), and healthy controls (HC; n = 15) were assessed and the MTPR at baseline and after 1 year were defined. The diagnostic accuracy of the MTPR and its relative change were evaluated using ROC curve analyses. Results PSP-patients had a significantly lower MTPR at baseline (M = 0.45 ± 0.06), compared to both non-PSP groups (F (2, 41) = 62.82, p < 0.001), with an overall predictive accuracy of 95.6% for an MTPR ≤ 0.54. PSP-patients also presented a significantly stronger 1-year decline in MTPR compared to IPD (p < 0.001). Though predictive accuracy of relΔt_MTPR for PSP (M = − 4.74% ± 4.48) from IPD (M = + 1.29 ± 3.77) was good (76.6%), ROC analysis did not reveal a significant improvement of diagnostic accuracy by combining the MTPR and relΔt_MTPR (p = 0.670). Still, specificity for PSP increased, though not significantly (p = 0.500). Conclusion The present results indicate that the relΔt_MTPR is a potentially useful tool to support the differential diagnosis of PSP from IPD. For its relative 1-year change, still, more evaluation is needed.
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Affiliation(s)
- Silja Kannenberg
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Julian Caspers
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Lars Dinkelbach
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Alexia-S Moldovan
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.,Department of Neurology, Medical Faculty, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Stefano Ferrea
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Martin Südmeyer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.,Department of Neurology, Ernst Von Bergmann Hospital, Charlottenstraße 72, 14467, Potsdam, Germany
| | - Markus Butz
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Christian J Hartmann
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.,Department of Neurology, Medical Faculty, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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2
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Alster P, Madetko N, Koziorowski D, Friedman A. Microglial Activation and Inflammation as a Factor in the Pathogenesis of Progressive Supranuclear Palsy (PSP). Front Neurosci 2020; 14:893. [PMID: 32982676 PMCID: PMC7492584 DOI: 10.3389/fnins.2020.00893] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/30/2020] [Indexed: 12/16/2022] Open
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disease based on four-repeat tauopathy pathology. Currently, this entity is not fully recognized in the context of pathogenesis or clinical examination. This review evaluates the association between neuroinflammation and microglial activation with the induction of pathological cascades that result in tauopathy pathology and the clinical manifestation of PSP. Multidimensional analysis was performed by evaluating genetic, biochemical, and neuroimaging biomarkers to determine whether neurodegeneration as an effect of neuroinflammation or neuroinflammation is a consequence of neurodegeneration in PSP. To the best of our knowledge, this review is the first to investigate PSP in this context.
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Affiliation(s)
- Piotr Alster
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Natalia Madetko
- Department and Clinic of Neurology, Wrocław Medical University, Wrocław, Poland
| | | | - Andrzej Friedman
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
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3
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Kelley KD, Checkoway H, Hall DA, Reich SG, Cunningham C, Litvan I. Traumatic Brain Injury and Firearm Use and Risk of Progressive Supranuclear Palsy Among Veterans. Front Neurol 2018; 9:474. [PMID: 29973911 PMCID: PMC6020251 DOI: 10.3389/fneur.2018.00474] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/31/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Progressive supranuclear palsy (PSP) is a tauopathy that has a multifactorial etiology. Numerous studies that have investigated lead exposure and traumatic brain injury (TBI) as risk factors for other tauopathies, such as Alzheimer's disease, but not for PSP. Objective: We sought to investigate the role of firearm usage, as a possible indicator of lead exposure, and TBI as risk factors for PSP in a population of military veterans. Methods: We included participants from a larger case-control study who reported previous military service. Our sample included 67 PSP cases and 68 controls. Participants were administered a questionnaire to characterize firearm use in the military and occurrence of TBI. Results: Cases were significantly less educated than controls. In unadjusted analyses, the proportion of PSP cases (80.6%) and controls (64.7%) who reported use of firearms as part of their military job was positively associated with PSP, odds ratio (OR) 2.2 (95% CI: 1-5.0). There were no significant case-control differences in mean service duration. There was only a weak association with history of TBI, OR 1.6 (95% CI: 0.8-3.4). In multivariate models, firearm usage (OR 3.7, 95% CI: 1.5, 9.8) remained significantly associated with PSP. Conclusions: Our findings show a positive association between firearm usage and PSP and an inverse association between education and PSP. The former suggests a possible etiologic role of lead. Further studies are needed to confirm the potential etiologic effects of metals on PSP. The study was registered in clinicaltrials.gov. ClinicalTrials.gov Identifier: NCT00431301.
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Affiliation(s)
- Kristen D. Kelley
- School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Harvey Checkoway
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA, United States
| | - Deborah A. Hall
- Department of Neurology, Rush University Medical Center, Chicago, IL, United States
| | - Stephen G. Reich
- Department of Neurology, University of Maryland, Baltimore, MD, United States
| | - Chris Cunningham
- Clinical Trials Unit, University of Louisville, Louisville, KY, United States
| | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
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4
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Park HK, Ilango S, Charriez CM, Checkoway H, Riley D, Standaert DG, Bordelon Y, Shprecher DR, Reich SG, Hall D, Kluger B, Marras C, Jankovic J, Dubinsky R, Litvan I. Lifetime exposure to estrogen and progressive supranuclear palsy: Environmental and Genetic PSP study. Mov Disord 2018; 33:468-472. [PMID: 29460982 PMCID: PMC5840026 DOI: 10.1002/mds.27336] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/10/2017] [Accepted: 01/11/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Studies suggesting a protective effect of estrogen in neurodegenerative diseases prompted us to investigate this relationship in progressive supranuclear palsy (PSP). METHODS This case-control study evaluated the self-reported reproductive characteristics and estrogen of 150 women with PSP and 150 age-matched female controls who participated in the Environmental Genetic-PSP study. Conditional logistic regression models were generated to examine associations of PSP with estrogen. RESULTS There was no association between years of estrogen exposure duration and PSP. There was a suggestion of an inverse association between composite estrogen score and PSP that did not reach statistical significance (P = .06). Any exposure to estrogen replacement therapy halved the risk of PSP (odds ratio = 0.52; 95% confidence interval = 0.30-0.92; P = .03). Among PSP cases, earlier age at menarche was associated with better performance on Hoehn and Yahr stage (β = -0.60; SE = 0.26; P = .02) and Unified Parkinson's Disease Rating Scale II score (β = -5.19; SE = 2.48; P = .04) at clinical examination. CONCLUSIONS This case-control study suggests a protective role of lifetime estrogen exposure in PSP. Future studies will be needed to confirm this association. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Hee Kyung Park
- Department of Neurology, Inje University Ilsan-Paik Hospital, Goyang, Korea
- Movement Disorder Center, Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - Sindana Ilango
- Graduate School of Public Health, San Diego State University
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Christina M. Charriez
- Movement Disorder Center, Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - Harvey Checkoway
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | | | - David G. Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yvette Bordelon
- Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - David R. Shprecher
- Banner Sun Health Research Institute, Sun City, AZ
- Department of Neurology, University of Arizona College of Medicine, Phoenix, AZ
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Stephen G. Reich
- Department of Neurology, University of Maryland, Baltimore, Maryland, USA
| | - Deborah Hall
- Department of Neurological Sciences, Rush University, Chicago, Illinois, USA
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Benzi Kluger
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Connie Marras
- Morto and Gloria Shulman Movement Disorders Centre and the Edmond J. Saftra Program in Parkinson’s Research, Toronto Western Hospital, University of Toronto, Toronto, Ontario, USA
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine
| | | | - Irene Litvan
- Movement Disorder Center, Department of Neurosciences, University of California San Diego, San Diego, California, USA
- Division of Movement Disorders, Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucky, USA
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5
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F-18 FP-CIT PET in Multiple System Atrophy of the Cerebellar Type: Additional Role in Treatment. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2017:8598705. [PMID: 29333110 PMCID: PMC5733227 DOI: 10.1155/2017/8598705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/14/2017] [Indexed: 12/18/2022]
Abstract
We evaluated the difference in the status of dopamine transporters (DATs) depending on Parkinsonism, cerebellar, and autonomic features using F-18 FP-CIT positron emission tomography (PET) in multiple system atrophy with cerebellar ataxia (MSA-C). We also assessed whether the DAT PET could be useful in the management of MSA-C. Forty-nine patients who were clinically diagnosed as possible to probable MSA-C were included. Based on the F-18 FP-CIT PET results, patients were classified into normal (n = 25) and abnormal (n = 24) scan groups. There were statistically significant differences in rigidity, bradykinesia, postural instability, asymmetry, and specific uptake ratio (SUR) between the two groups but no significant differences in tremor and cerebellar/autonomic symptoms. Dopaminergic medications were administered to 22 patients. All seven patients with normal scans showed no change, while 10 of the 15 patients with abnormal scans showed clinical improvement. There was a trend of a negative correlation between levodopa equivalent dose and SUR, but it was not statistically significant. DAT imaging, such as F-18 FP-CIT PET, may be useful in predicting the response to dopaminergic medication regardless of cerebellar/autonomic symptoms in MSA-C. In addition to being used for the diagnosis of the disease, it may be used as a treatment decision index.
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Power BD, Jakabek D, Hunter-Dickson M, Wilkes FA, van Westen D, Santillo AF, Walterfang M, Velakoulis D, Nilsson C, Looi JCL. Morphometric analysis of thalamic volume in progressive supranuclear palsy: In vivo evidence of regionally specific bilateral thalamic atrophy. Psychiatry Res Neuroimaging 2017; 265:65-71. [PMID: 28550719 DOI: 10.1016/j.pscychresns.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/11/2017] [Accepted: 05/11/2017] [Indexed: 11/25/2022]
Abstract
We investigated whether differences were detectable in the volume and shape of the dorsal thalamus on magnetic resonance imaging in patients with progressive supranuclear palsy (PSP). Manual segmentation of the left and right thalami on magnetic resonance imaging scans occurred in 22 patients with clinically diagnosed PSP and 23 healthy controls; thalamic volumes (left, right, total) were calculated. Between group differences were explored by multivariate analysis of co-variance, using age and intracranial volume as covariates. Analysis of the shape of the thalamus was performed using the spherical harmonic point distribution method software package. Patients with PSP were found to have significant bilateral thalamic atrophy on magnetic resonance imaging; there was significant shape deflation over the anterior-lateral and anterior-ventral surfaces bilaterally, and over the right caudal thalamus. Recognizing decreased thalamic morphology in PSP patients in vivo may be an important component of an ensemble of diagnostic biomarkers in the future, particularly given the difficulty of distinguishing PSP from other Parkinsonian conditions early in the disease course.
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Affiliation(s)
- Brian D Power
- School of Medicine Fremantle, The University of Notre Dame Australia, Fremantle, Australia; Clinical Research Centre, North Metropolitan Health Service - Mental Health, Perth, Australia.
| | - David Jakabek
- University of Wollongong, Wollongong, NSW, Australia.
| | - Mitchell Hunter-Dickson
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, Australia.
| | - Fiona A Wilkes
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, Australia.
| | - Danielle van Westen
- Center for Medical Imaging and Physiology, Skåne University Hospital, and Diagnostic Radiology, Department of Clinical Sciences, Lund University, Lund, Sweden; Diagnostic Radiology, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Alexander F Santillo
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Neuropsychiatry Centre, Melbourne, Australia.
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Neuropsychiatry Centre, Melbourne, Australia.
| | - Christer Nilsson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Jeffrey C L Looi
- Research Centre for the Neurosciences of Ageing, Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, Australia; Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Neuropsychiatry Centre, Melbourne, Australia
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7
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Möller L, Kassubek J, Südmeyer M, Hilker R, Hattingen E, Egger K, Amtage F, Pinkhardt EH, Respondek G, Stamelou M, Möller F, Schnitzler A, Oertel WH, Knake S, Huppertz HJ, Höglinger GU. Manual MRI morphometry in Parkinsonian syndromes. Mov Disord 2017; 32:778-782. [PMID: 28150443 DOI: 10.1002/mds.26921] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/01/2016] [Accepted: 12/20/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Several morphometric magnetic resonance imaging parameters may serve for differential diagnosis of parkinsonism. The objective of this study was to identify which performs best in clinical routine. METHODS We acquired multicentric magnetization-prepared rapid gradient echo sequences in patients with Parkinson's disease (n=204), progressive supranuclear palsy (n=106), multiple system atrophy-cerebellar, (n = 21); multiple system atrophy-parkinsonian (n = 60), and healthy controls (n = 73), performed manual planimetric measurements, and calculated receiver operator characteristics with leave-one-out cross-validation to propose cutoff values. RESULTS The midsagittal midbrain area was reduced in PSP versus all other groups (P < 0.001). The midsagittal pons area was reduced in MSA-cerebellar, MSA-parkinsonian, and PSP versus PD patients and healthy controls (P < 0.001). The midbrain/pons area ratio was lower in PSP (P < 0.001) and higher in MSA-cerebellar and MSA-parkinsonian versus PD and PSP (P < 0.001). CONCLUSIONS The midsagittal midbrain area most reliably identified PSP, the midsagittal pons area MSA-cerebellar. The midbrain/pons area ratio differentiated MSA-cerebellar and PSP better than the magnetic resonance-Parkinson index. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Leona Möller
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Martin Südmeyer
- Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Rüdiger Hilker
- Departement of Neurology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Karl Egger
- Department of Neuroradiology, Medical University Center Freiburg, Freiburg, Germany
| | - Florian Amtage
- Department of Neurology, Medical University Center Freiburg, Freiburg, Germany
| | | | - Gesine Respondek
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Department of Neurology, Technische Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Maria Stamelou
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Parkinson's Disease and Movement Disorders Department, HYGEIA Hospital, Athens, Greece and Second Dept. of Neurology, Attikon Hospital, University of Athens Greece
| | - Franz Möller
- Department of Children and Youth Medicine, Philipps University Marburg, Marburg, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, and Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang H Oertel
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | - Susanne Knake
- Department of Neurology, Philipps University Marburg, Marburg, Germany
| | | | - Günter U Höglinger
- Department of Neurology, Philipps University Marburg, Marburg, Germany.,Department of Neurology, Medical University Center Freiburg, Freiburg, Germany.,Department of Neurology, Technische Universität München, Munich, Germany
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8
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Progressive supranuclear palsy and corticobasal degeneration: Diagnostic challenges and clinicopathological considerations. Rev Neurol (Paris) 2016; 172:488-502. [DOI: 10.1016/j.neurol.2016.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/04/2016] [Accepted: 07/12/2016] [Indexed: 11/22/2022]
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9
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Characteristics of Nonmotor Symptoms in Progressive Supranuclear Palsy. PARKINSONS DISEASE 2016; 2016:9730319. [PMID: 27366342 PMCID: PMC4913008 DOI: 10.1155/2016/9730319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/11/2016] [Indexed: 02/05/2023]
Abstract
Objectives. To explore the clinical correlates of nonmotor symptoms (NMS) in progressive supranuclear palsy (PSP) and their differences from healthy controls and patients with Parkinson's disease (PD). Methods. Twenty-seven PSP patients, 27 age- and gender-matched healthy controls (HC), and 27 age- and gender-matched PD patients were included for this case-control study. NMS were assessed using the Nonmotor Symptoms Scale (NMSS, including 9 domains). Results. All PSP patients reported NMS. The frequency and severity of "sleep/fatigue," "mood/apathy," "attention/memory," "gastrointestinal," "sexual dysfunction," and "miscellaneous" domains in PSP group were significantly higher than those in HC group (P < 0.05). The frequency of "mood/apathy," "attention/memory," and "sexual dysfunction" domains and the severity of "attention/memory" and "gastrointestinal" domains in PSP group were significantly higher than those in PD group (P < 0.05). The "attention/memory" domain in PSP had a significant but weak-to-moderate correlation with age (R = 0.387, P = 0.046) and onset age (R = 0.406, P = 0.036). Conclusions. NMS are common in PSP patients. Patients with PSP seem to be subjected to more frequent and severe specific NMS compared to healthy aging subjects and PD patients. Older PSP patients and late-onset patients are likely to be subjected to cognitive decline.
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10
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Litvan I, Lees PSJ, Cunningham CR, Rai SN, Cambon AC, Standaert DG, Marras C, Juncos J, Riley D, Reich S, Hall D, Kluger B, Bordelon Y, Shprecher DR. Environmental and occupational risk factors for progressive supranuclear palsy: Case-control study. Mov Disord 2016; 31:644-52. [PMID: 26854325 DOI: 10.1002/mds.26512] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The cause of progressive supranuclear palsy (PSP) is largely unknown. Based on evidence for impaired mitochondrial activity in PSP, we hypothesized that the disease may be related to exposure to environmental toxins, some of which are mitochondrial inhibitors. METHODS This multicenter case-control study included 284 incident PSP cases of 350 cases and 284 age-, sex-, and race-matched controls primarily from the same geographical areas. All subjects were administered standardized interviews to obtain data on demographics, residential history, and lifetime occupational history. An industrial hygienist and a toxicologist unaware of case status assessed occupational histories to estimate past exposure to metals, pesticides, organic solvents, and other chemicals. RESULTS Cases and controls were similar on demographic factors. In unadjusted analyses, PSP was associated with lower education, lower income, more smoking pack-years, more years of drinking well water, more years living on a farm, more years living 1 mile from an agricultural region, more transportation jobs, and more jobs with exposure to metals in general. However, in adjusted models, only more years of drinking well water was significantly associated with PSP. There was an inverse association with having a college degree. CONCLUSIONS We did not find evidence for a specific causative chemical exposure; higher number of years of drinking well water is a risk factor for PSP. This result remained significant after adjusting for income, smoking, education and occupational exposures. This is the first case-control study to demonstrate PSP is associated with environmental factors. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Irene Litvan
- Division of Movement Disorders, Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucy, USA.,Movement Disorder Center, Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - Peter S J Lees
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christopher R Cunningham
- Division of Movement Disorders, Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucy, USA
| | - Shesh N Rai
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, Kentucky, USA
| | - Alexander C Cambon
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, Kentucky, USA
| | - David G Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Connie Marras
- Morto and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Research, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jorge Juncos
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | | | - Stephen Reich
- Department of Neurology, University of Maryland, Baltimore, Maryland, USA
| | - Deborah Hall
- Department of Neurological Sciences, Rush University, Chicago, Illinois, USA.,Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Benzi Kluger
- Department of Neurology, University of Colorado, Denver, Colorado, USA
| | - Yvette Bordelon
- Department of Neurology, University of California Los Angeles, California, USA
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Abstract
Young-onset dementia is a broad category of diseases that affect adults before the age of 65, with devastating effects on individuals and families. Neuroimaging plays a clear and ever-expanding role in the workup of these diseases. MRI demonstrates classic patterns of atrophy that help to confirm the clinical diagnosis and may predict the underlying disease. Functional nuclear imaging, such as PET, demonstrates areas of brain dysfunction even in the absence of visible atrophy. These techniques can inform important aspects of the care of young-onset dementia, such as the underlying pathologic condition, treatment, and prognosis.
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Affiliation(s)
- HyungSub Shim
- Department of Neurology, University of Iowa Hospitals and Clinics, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Maria J Ly
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Sarah K Tighe
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
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12
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Rosskopf J, Müller HP, Huppertz HJ, Ludolph AC, Pinkhardt EH, Kassubek J. Frontal corpus callosum alterations in progressive supranuclear palsy but not in Parkinson's disease. NEURODEGENER DIS 2014; 14:184-93. [PMID: 25377379 DOI: 10.1159/000367693] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 08/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Frontal lobe involvement is considered a clinical and magnetic resonance imaging (MRI) feature in later stages of progressive supranuclear palsy (PSP). OBJECTIVE Diffusion tensor imaging (DTI) was used to investigate the integrity of frontal pathways in PSP and Parkinson's disease (PD) patients. METHODS DTI and 3-D MRI were performed in 15 PSP patients (parkinsonism subtype: n = 8; Richardson subtype: n = 7), 15 PD patients, and 18 matched controls. DTI analysis was performed in order to identify differences along frontal white matter structures including the corpus callosum (CC) and was complemented by atlas-based volumetry and planimetry. RESULTS Significantly reduced regional fractional anisotropy was observed for PSP patients versus controls and PSP versus PD patients, respectively, in frontal areas including the area II of the CC and bilaterally in the callosal radiation. The DTI findings correlated with frontal lobe volumes. These differences were not observed between PD patients and controls. CONCLUSION DTI identified a PSP-associated microstructural alteration pattern in the frontal lobes and in the CC area II including the corresponding bilateral callosal radiation tracts that could not be identified in both control samples, supporting the prominent PSP-associated frontal involvement as a potential neuroimaging marker.
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Niethammer M, Tang CC, Feigin A, Allen PJ, Heinen L, Hellwig S, Amtage F, Hanspal E, Vonsattel JP, Poston KL, Meyer PT, Leenders KL, Eidelberg D. A disease-specific metabolic brain network associated with corticobasal degeneration. ACTA ACUST UNITED AC 2014; 137:3036-46. [PMID: 25208922 DOI: 10.1093/brain/awu256] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Corticobasal degeneration is an uncommon parkinsonian variant condition that is diagnosed mainly on clinical examination. To facilitate the differential diagnosis of this disorder, we used metabolic brain imaging to characterize a specific network that can be used to discriminate corticobasal degeneration from other atypical parkinsonian syndromes. Ten non-demented patients (eight females/two males; age 73.9 ± 5.7 years) underwent metabolic brain imaging with (18)F-fluorodeoxyglucose positron emission tomography for atypical parkinsonism. These individuals were diagnosed clinically with probable corticobasal degeneration. This diagnosis was confirmed in the three subjects who additionally underwent post-mortem examination. Ten age-matched healthy subjects (five females/five males; age 71.7 ± 6.7 years) served as controls for the imaging studies. Spatial covariance analysis was applied to scan data from the combined group to identify a significant corticobasal degeneration-related metabolic pattern that discriminated (P < 0.001) the patients from the healthy control group. This pattern was characterized by bilateral, asymmetric metabolic reductions involving frontal and parietal cortex, thalamus, and caudate nucleus. These pattern-related changes were greater in magnitude in the cerebral hemisphere opposite the more clinically affected body side. The presence of this corticobasal degeneration-related metabolic topography was confirmed in two independent testing sets of patient and control scans, with elevated pattern expression (P < 0.001) in both disease groups relative to corresponding normal values. We next determined whether prospectively computed expression values for this pattern accurately discriminated corticobasal degeneration from multiple system atrophy and progressive supranuclear palsy (the two most common atypical parkinsonian syndromes) on a single case basis. Based upon this measure, corticobasal degeneration was successfully distinguished from multiple system atrophy (P < 0.001) but not progressive supranuclear palsy, presumably because of the overlap (∼ 24%) that existed between the corticobasal degeneration- and the progressive supranuclear palsy-related metabolic topographies. Nonetheless, excellent discrimination between these disease entities was achieved by computing hemispheric asymmetry scores for the corticobasal degeneration-related pattern on a prospective single scan basis. Indeed, a logistic algorithm based on the asymmetry scores combined with separately computed expression values for a previously validated progressive supranuclear palsy-related pattern provided excellent specificity (corticobasal degeneration: 92.7%; progressive supranuclear palsy: 94.1%) in classifying 58 testing subjects. In conclusion, corticobasal degeneration is associated with a reproducible disease-related metabolic covariance pattern that may help to distinguish this disorder from other atypical parkinsonian syndromes.
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Affiliation(s)
- Martin Niethammer
- 1 Centre for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA
| | - Chris C Tang
- 1 Centre for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA
| | - Andrew Feigin
- 1 Centre for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA
| | - Patricia J Allen
- 1 Centre for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA
| | - Lisette Heinen
- 2 Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sabine Hellwig
- 3 Department of Neurology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Amtage
- 3 Department of Neurology, University Hospital Freiburg, Freiburg, Germany
| | - Era Hanspal
- 4 Parkinson's Disease and Movement Disorders Centre, Albany Medical Centre, Albany, NY 12208, USA
| | - Jean Paul Vonsattel
- 5 The New York Brain Bank, Columbia Presbyterian Medical Centre, New York, NY 10032, USA
| | - Kathleen L Poston
- 6 Department of Neurology and Neurological Sciences, Stanford University Medical Centre, Stanford, CA 94305, USA
| | - Philipp T Meyer
- 7 Department of Nuclear Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Klaus L Leenders
- 2 Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands
| | - David Eidelberg
- 1 Centre for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA
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Bloise MC, Berardelli I, Roselli V, Pasquini M, Stirpe P, Colosimo C, Berardelli A, Fabbrini G. Psychiatric disturbances in patients with progressive supranuclear palsy: A case-control study. Parkinsonism Relat Disord 2014; 20:965-8. [DOI: 10.1016/j.parkreldis.2014.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/23/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
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Esteves AR, Gozes I, Cardoso SM. The rescue of microtubule-dependent traffic recovers mitochondrial function in Parkinson's disease. Biochim Biophys Acta Mol Basis Dis 2013; 1842:7-21. [PMID: 24120997 DOI: 10.1016/j.bbadis.2013.10.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/30/2013] [Accepted: 10/04/2013] [Indexed: 11/25/2022]
Abstract
In Parkinson's disease mitochondrial dysfunction can lead to a deficient ATP supply to microtubule protein motors leading to mitochondrial axonal transport disruption. Compromised axonal transport will then lead to a disorganized distribution of mitochondria and other organelles in the cell, as well as, the accumulation of aggregated proteins like alpha-synuclein. Moreover, axonal transport disruption can trigger synaptic accumulation of autophagosomes packed with damaged mitochondria and protein aggregates promoting synaptic failure. We previously observed that neuronal-like cells with an inherent mitochondrial impairment derived from PD patients contain a disorganized microtubule network, as well as, alpha-synuclein oligomer accumulation. In this work we provide new evidence that an agent that promotes microtubule network assembly, NAP (davunetide), improves microtubule-dependent traffic, restores the autophagic flux and potentiates autophagosome-lysosome fusion leading to autophagic vacuole clearance in Parkinson's disease cells. Moreover, NAP is capable of efficiently reducing alpha-synuclein oligomer content and its sequestration by the mitochondria. Most interestingly, NAP decreases mitochondrial ubiquitination levels, as well as, increases mitochondrial membrane potential indicating a rescue in mitochondrial function. Overall, we demonstrate that by improving microtubule-mediated traffic, we can avoid mitochondrial-induced damage and thus recover cell homeostasis. These results prove that NAP may be a promising therapeutic lead candidate for neurodegenerative diseases that involve axonal transport failure and mitochondrial impairment as hallmarks, like Parkinson's disease and related disorders.
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Affiliation(s)
- A R Esteves
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Portugal
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16
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Saleem TZ, Higginson IJ, Chaudhuri KR, Martin A, Burman R, Leigh PN. Symptom prevalence, severity and palliative care needs assessment using the Palliative Outcome Scale: a cross-sectional study of patients with Parkinson's disease and related neurological conditions. Palliat Med 2013. [PMID: 23208011 DOI: 10.1177/0269216312465783] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative care is rarely being offered to patients with Parkinson's disease. AIM To assess symptom prevalence, severity and palliative care needs in advanced stages of Parkinsonism. DESIGN A cross-sectional survey using a palliative care assessment tool, the Palliative Outcome Scale was administered to patients. SETTING/PARTICIPANTS Eight-two patients with a diagnosis of idiopathic Parkinson's disease, multiple systems atrophy or progressive supranuclear palsy were included in the study. RESULTS Their mean age and disease stages 3-5 Hoehn and Yahr were 67 years and 4.1, respectively. Patients reported a mean of 10.7 (standard deviation = 3.9) physical symptoms. Over 80% had pain, fatigue, day time somnolence and problems with mobility. Other symptoms in 50%-80% included constipation, loss of bladder control, swallowing difficulties, drooling, breathlessness and sleep problems. Symptoms rated as causing severe problems were pain, fatigue, constipation and drooling. Assessment of mood revealed 70% of the patients felt anxiety and 60% had felt depressed. Eight-five per cent felt their families were anxious or worried about them. Thirty-eight per cent would have liked more information and 42% had practical problems that still needed to be addressed. There was a positive correlation between number of symptoms and disease severity (r = 0.39, p = 0.01). The total mean Palliative Outcome Scale score was 13.6 (standard deviation = 6.1), suggesting moderate palliative care needs. CONCLUSION This is the first study to describe the care needs of people with Parkinson's disease using the Palliative Outcome Scale tool. The burden of symptoms and concerns was high in advanced stages of disease. It might be appropriate that people severely affected by these conditions should be considered for referral to specialist palliative care services.
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Affiliation(s)
- Tariq Z Saleem
- Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, London, UK.
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17
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Sastre-Bataller I, Vázquez JF, Martínez-Torres I, Sahuquillo P, Rubio-Agustí I, Burguera JA, Ferrer JM, Valero C, Tembl JI. Mesencephalic area measured by transcranial sonography in the differential diagnosis of parkinsonism. Parkinsonism Relat Disord 2013; 19:732-6. [PMID: 23684370 DOI: 10.1016/j.parkreldis.2013.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 03/10/2013] [Accepted: 04/16/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transcranial B-mode sonography (TCS) has become an important tool in the differential diagnosis of parkinsonism given that current technology enables an adequate assessment of brain structures. In this study we aimed at evaluating the usefulness of midbrain area measured by TCS in the differential diagnosis between Parkinson's Disease (PD) and Progressive Supranuclear Palsy (PSP). METHODS Patients with a diagnosis of PD or PSP according to current clinical criteria were recruited. PSP patients were classified as Richardson's syndrome and PSP-parkinsonism. TCS was performed and the mesencephalic area and third ventricle width were measured offline by an examiner blinded to clinical diagnosis. RESULTS TCS was performed in 60 patients (75% PD, 25% PSP). Eight patients (13,3%) had inadequate acoustic window. Patients with PSP had a smaller mesencephalic area (3.58 cm(2) vs 5.28 cm(2), p < 0.001). A mesencephalic area ≥4.27 cm(2) discriminates PD from PSP with a positive predictive value 100%. Patients with PSP also had a higher third ventricle diameter (8.84 mm vs 5.11 mm, p < 0.001). Within the PSP group patients with Richardson's syndrome had a wider third ventricle than patients with PSP-Parkinsonism phenotype (9.57 mm vs 7 mm, p = 0.01), but no differences were found in the mesencephalic area between both phenotypes. CONCLUSIONS Measurement of the mesencephalic area and the third ventricle width by TCS is a non-invasive, easily accessible technique that is useful in the differential diagnosis between PD and PSP, at least in the late stages of the disease.
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Kamiya K, Sato N, Ota M, Nakata Y, Ito K, Kimura Y, Murata M, Mori H, Kunimatsu A, Ohtomo K. Diffusion tensor tract-specific analysis of the uncinate fasciculus in patients with progressive supranuclear palsy. J Neuroradiol 2013; 40:121-9. [DOI: 10.1016/j.neurad.2012.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 05/29/2012] [Accepted: 06/23/2012] [Indexed: 12/14/2022]
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Constantinescu R, Mondello S. Cerebrospinal fluid biomarker candidates for parkinsonian disorders. Front Neurol 2013; 3:187. [PMID: 23346074 PMCID: PMC3549487 DOI: 10.3389/fneur.2012.00187] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 12/21/2012] [Indexed: 01/21/2023] Open
Abstract
The Parkinsonian disorders are a large group of neurodegenerative diseases including idiopathic Parkinson’s disease (PD) and atypical Parkinsonian disorders (APD), such as multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, and dementia with Lewy bodies. The etiology of these disorders is not known although it is considered to be a combination of genetic and environmental factors. One of the greatest obstacles for developing efficacious disease-modifying treatment strategies is the lack of biomarkers. Reliable biomarkers are needed for early and accurate diagnosis, to measure disease progression, and response to therapy. In this review several of the most promising cerebrospinal biomarker candidates are discussed. Alpha-synuclein seems to be intimately involved in the pathogenesis of synucleinopathies and its levels can be measured in the cerebrospinal fluid and in plasma. In a similar way, tau protein accumulation seems to be involved in the pathogenesis of tauopathies. Urate, a potent antioxidant, seems to be associated to the risk of developing PD and with its progression. Neurofilament light chain levels are increased in APD compared with PD and healthy controls. The new “omics” techniques are potent tools offering new insights in the patho-etiology of these disorders. Some of the difficulties encountered in developing biomarkers are discussed together with future perspectives.
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Affiliation(s)
- Radu Constantinescu
- Department of Neurology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg Gothenburg, Sweden
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Saini J, Bagepally BS, Sandhya M, Pasha SA, Yadav R, Pal PK. In vivo evaluation of white matter pathology in patients of progressive supranuclear palsy using TBSS. Neuroradiology 2011; 54:771-80. [PMID: 22160214 DOI: 10.1007/s00234-011-0983-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 11/14/2011] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The purpose of this research is to study white matter (WM) changes in patients of progressive supranuclear palsy (PSP) using automated analysis of diffusion tensor imaging (DTI) indices. METHODS This was a prospective study comprising of 24 patients of PSP and 26 matched healthy controls. Fractional anisotropy, mean diffusivity (MD), axial diffusivity, and radial diffusivity (RD) changes were studied in the WM of the PSP patients using an automated analysis technique, tract-based spatial statistics (TBSS). Two subtypes of PSP, i.e., classic Richardson's syndrome (PSP-RS) and parkinsonian type (PSP-P), were also compared among themselves to identify relative severity of WM changes as well as identify spatial distribution of the differences. Clinicoradiological correlation was done to determine the strength of correlation between WM abnormalities identified using TBSS and clinical scores. RESULTS There were areas of significant abnormality seen in the frontoparietal cerebral WM, thalamus, midbrain tectum, superior cerebellar peduncle, and cerebellar WM. The abnormalities were more spatially widespread on MD and RD maps. Compared to PSP-P, the patients of PSP-RS had more spatial abnormalities localized to the frontal WM. There was no correlation between the observed WM changes and clinical rating scales. CONCLUSIONS The TBSS analysis showed widespread WM abnormalities in PSP patients including areas which have been shown to be involved in previous pathological studies. PSP-RS showed more severe white matter abnormality compared to the PSP-P subtype.
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Affiliation(s)
- Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore, 560029 Karnataka, India
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McCrone P, Payan CAM, Knapp M, Ludolph A, Agid Y, Leigh PN, Bensimon G. The economic costs of progressive supranuclear palsy and multiple system atrophy in France, Germany and the United Kingdom. PLoS One 2011; 6:e24369. [PMID: 21931694 PMCID: PMC3169589 DOI: 10.1371/journal.pone.0024369] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 08/08/2011] [Indexed: 11/18/2022] Open
Abstract
Progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) are progressive disabling neurological conditions usually fatal within 10 years of onset. Little is known about the economic costs of these conditions. This paper reports service use and costs from France, Germany and the UK and identifies patient characteristics that are associated with cost. 767 patients were recruited, and 760 included in the study, from 44 centres as part of the NNIPPS trial. Service use during the previous six months was measured at entry to the study and costs calculated. Mean six-month costs were calculated for 742 patients. Data on patient sociodemographic and clinical characteristics were recorded and used in regression models to identify predictors of service costs and unpaid care costs (i.e., care from family and friends). The mean six-month service costs of PSP were €24,491 in France, €30,643 in Germany and €25,655 in the UK. The costs for MSA were €28,924, €25,645 and €19,103 respectively. Unpaid care accounted for 68-76%. Formal and unpaid costs were significantly higher the more severe the illness, as indicated by the Parkinson's Plus Symptom scale. There was a significant inverse relationship between service and unpaid care costs.
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Affiliation(s)
- Paul McCrone
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom.
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22
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Kvickström P, Eriksson B, van Westen D, Lätt J, Elfgren C, Nilsson C. Selective frontal neurodegeneration of the inferior fronto-occipital fasciculus in progressive supranuclear palsy (PSP) demonstrated by diffusion tensor tractography. BMC Neurol 2011; 11:13. [PMID: 21269463 PMCID: PMC3041656 DOI: 10.1186/1471-2377-11-13] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 01/26/2011] [Indexed: 11/22/2022] Open
Abstract
Background The clinical presentation in progressive supranuclear palsy (PSP), an atypical parkinsonian disorder, includes varying degrees of frontal dysexecutive symptoms. Using diffusion tensor imaging (DTI) and tractography (DTT), we investigated whether diffusion changes and atrophy of the inferior fronto-occipital fasciculus (IFO) occurs in PSP and if these changes correlate with disease stage and clinical phenotype. The corticospinal tract (CST), which is often involved in PSP, was investigated for comparison. Methods DTI of the whole brain was performed with a 3 T MR scanner using a single shot-EPI sequence with diffusion encoding in 48 directions. Scans were obtained in patients with PSP (n = 13) and healthy age-matched controls (n = 12). DTT of the IFO and CST was performed with the PRIDE fibre tracking tool (Philips Medical System). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated and correlated with disease stage and clinical phenotype. Results In patients with PSP, significantly decreased FA and increased ADC was found in the frontal part of IFO compared with the medial and occipital parts of IFO, as well as compared to controls. Four of the thirteen patients with PSP showed a marked decrease in the number of tracked voxels in the frontal part of IFO. These findings were most pronounced in patients with severe frontal cognitive symptoms, such as dysexecutive problems, apathy and personality change. There was a strong correlation (r2 = -0.84; p < 0,001) between disease stage and FA and ADC values in the CST. Conclusions DTT for identification of neuronal tracts with subsequent measurement of FA and ADC is a useful diagnostic tool for demonstrating patterns of neuronal tract involvement in neurodegenerative disease. In selected tracts, FA and ADC values might act as surrogate markers for disease stage.
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Affiliation(s)
- Pia Kvickström
- Geriatric Psychiatry, Department of Clinical Sciences, Lund University, Klinikgatan 22, 22185 Lund, Sweden
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Stamelou M, Knake S, Oertel WH, Höglinger GU. Magnetic resonance imaging in progressive supranuclear palsy. J Neurol 2010; 258:549-58. [PMID: 21181185 DOI: 10.1007/s00415-010-5865-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 11/20/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
Abstract
Progressive supranuclear palsy (PSP) is a tauopathy, presenting clinically most often with a symmetrical akinetic-rigid syndrome, postural instability, supranuclear gaze palsy and frontal dementia. In the absence of reliably validated biomarkers, the diagnosis of PSP in vivo is presently based on clinical criteria, which to date do not include supporting imaging findings, as is accepted for other neurodegenerative diseases. However, data from conventional magnetic resonance imaging (MRI) and various advanced MRI techniques including magnetic resonance volumetry, voxel-based morphometry, diffusion-weighted and diffusion-tensor imaging, magnetization transfer imaging and proton resonance spectroscopy suggest that MRI can contribute valuable information for the differential diagnosis of PSP. We review here the presently published literature concerning MRI in PSP and discuss the potential role of MRI in differentiating PSP from other parkinsonian syndromes.
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Affiliation(s)
- M Stamelou
- Department of Neurology, Philipps University, Rudolf-Bultmann Str. 8, 35033, Marburg, Germany.
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Constantinescu R, Andreasson U, Li S, Podust VN, Mattsson N, Anckarsäter R, Anckarsäter H, Rosengren L, Holmberg B, Blennow K, Wikkelsö C, Rüetschi U, Zetterberg H. Proteomic profiling of cerebrospinal fluid in parkinsonian disorders. Parkinsonism Relat Disord 2010; 16:545-9. [DOI: 10.1016/j.parkreldis.2010.06.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 06/01/2010] [Accepted: 06/15/2010] [Indexed: 12/27/2022]
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Stamelou M, de Silva R, Arias-Carrión O, Boura E, Höllerhage M, Oertel WH, Müller U, Höglinger GU. Rational therapeutic approaches to progressive supranuclear palsy. Brain 2010; 133:1578-90. [PMID: 20472654 DOI: 10.1093/brain/awq115] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Progressive supranuclear palsy is a sporadic and progressive neurodegenerative disease, most often presenting as a symmetric, akinetic-rigid syndrome with postural instability, vertical supranuclear gaze palsy and frontal lobe deficits. It belongs to the family of tauopathies and involves both cortical and subcortical structures. Although the exact pathophysiology is not yet fully understood, several lines of evidence point to a crucial contribution from both genetic predisposition and mitochondrial dysfunction. Recently gained insights into the pathophysiology of this disease have led to several hypothesis-driven therapeutic approaches aiming at disease-modification rather than mere symptomatic neurotransmitter-replacement therapy. Agents targeting mitochondrial dysfunction have already shown a positive effect in a phase II study and further studies to verify and expand these results are ongoing. Clinical studies with agents targeting tau dysfunction such as tau-kinase inhibitors, tau-aggregation inhibitors and microtubule stabilizers are in preparation or ongoing. This review presents the current pathophysiological concepts driving these exciting therapeutic developments.
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Affiliation(s)
- Maria Stamelou
- Department of Neurology, Philipps University, Rudolf-Bultmann Str. 8, D-35033 Marburg, Germany
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Winter Y, Bezdolnyy Y, Katunina E, Avakjan G, Reese JP, Klotsche J, Oertel WH, Dodel R, Gusev E. Incidence of Parkinson's disease and atypical parkinsonism: Russian population-based study. Mov Disord 2010; 25:349-56. [DOI: 10.1002/mds.22966] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Bensimon G, Ludolph A, Agid Y, Vidailhet M, Payan C, Leigh PN. Riluzole treatment, survival and diagnostic criteria in Parkinson plus disorders: the NNIPPS study. ACTA ACUST UNITED AC 2008; 132:156-71. [PMID: 19029129 PMCID: PMC2638696 DOI: 10.1093/brain/awn291] [Citation(s) in RCA: 234] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Parkinson plus diseases, comprising mainly progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) are rare neurodegenerative conditions. We designed a double-blind randomized placebo-controlled trial of riluzole as a potential disease-modifying agent in Parkinson plus disorders (NNIPPS: Neuroprotection and Natural History in Parkinson Plus Syndromes). We analysed the accuracy of our clinical diagnostic criteria, and studied prognostic factors for survival. Patients with an akinetic-rigid syndrome diagnosed as having PSP or MSA according to modified consensus diagnostic criteria were considered for inclusion. The psychometric validity (convergent and predictive) of the NNIPPS diagnostic criteria were tested prospectively by clinical and pathological assessments. The study was powered to detect a 40% decrease in relative risk of death within PSP or MSA strata. Patients were randomized to riluzole or matched placebo daily and followed up to 36 months. The primary endpoint was survival. Secondary efficacy outcomes were rates of disease progression assessed by functional measures. A total of 767 patients were randomized and 760 qualified for the Intent to Treat (ITT) analysis, stratified at entry as PSP (362 patients) or MSA (398 patients). Median follow-up was 1095 days (range 249–1095). During the study, 342 patients died and 112 brains were examined for pathology. NNIPPS diagnostic criteria showed for both PSP and MSA excellent convergent validity with the investigators’ assessment of diagnostic probability (point-biserial correlation: MSA rpb = 0.93, P< 0.0001; PSP, rpb = 0.95, P< 0.0001), and excellent predictive validity against histopathology [sensitivity and specificity (95% CI) for PSP 0.95 (0.88–0.98) and 0.84 (0.77–0.87); and for MSA 0.96 (0.88–0.99) and 0.91 (0.86–0.93)]. There was no evidence of a drug effect on survival in the PSP or MSA strata (3 year Kaplan–Meier estimates PSP-riluzole: 0.51, PSP-placebo: 0.50; MSA-riluzole: 0.53, MSA-placebo: 0.58; P = 0.66 and P = 0.48 by the log-rank test, respectively), or in the population as a whole (P = 0.42, by the stratified-log-rank test). Likewise, rate of progression was similar in both treatment groups. There were no unexpected adverse effects of riluzole, and no significant safety concerns. Riluzole did not have a significant effect on survival or rate of functional deterioration in PSP or MSA, although the study reached over 80% power to detect the hypothesized drug effect within strata. The NNIPPS diagnostic criteria were consistent and valid. They can be used to distinguish between PSP and MSA with high accuracy, and should facilitate research into these conditions relatively early in their evolution.
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Affiliation(s)
- Gilbert Bensimon
- Département de Pharmacologie Clinique, Hôpital de la Pitié-Salpétrière, Assistance Publique Hôpitaux de Paris & UPMC University Paris 06, UMR 7087, Paris, France
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Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is the second most common cause of parkinsonism after Parkinson's disease (PD). The classic syndrome of PSP is widely recognized by neurologists as a combination of down gaze palsy with progressive rigidity and imbalance leading to falls. At the same time, few clinicians are proficient at treating PSP and recognizing the nonclassic presentations of this debilitating disorder often resulting in delays in diagnosis and misguided treatment. REVIEW SUMMARY Over the last decade many lines of investigation have helped refine PSP at the clinical, neuroimaging, pharmacologic and molecular levels. It is the purpose of this literature review to help clinicians identify PSP earlier in its course, to better understand its pathophysiology, and to provide a more focused, symptom-based treatment approach. Eighty-two peer-reviewed articles on the topic of PSP and other neurodegenerative disorders have been reviewed. CONCLUSION It is clear that PSP continues to be an under-recognized disorder with multilevel involvement of the neuraxis that helps differentiate it from other akinetic rigid syndromes such as PD. A greater appreciation of its atypical presentations, more attention to its neurobehavioral signs and better imaging techniques are some of the advances that will help facilitate earlier detection, which may reduce morbidity by helping anticipate early falls and minimizing unnecessary diagnostic procedures. Surgical approaches to PSP have been ineffective so far. Carefully targeted symptomatic treatment with drugs and other therapies is available and effective at reducing morbidity and improving quality of life.
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Cosottini M, Ceravolo R, Faggioni L, Lazzarotti G, Michelassi MC, Bonuccelli U, Murri L, Bartolozzi C. Assessment of midbrain atrophy in patients with progressive supranuclear palsy with routine magnetic resonance imaging. Acta Neurol Scand 2007; 116:37-42. [PMID: 17587253 DOI: 10.1111/j.1600-0404.2006.00767.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess midbrain atrophy through morphometric (linear, surface and volumetric) measurements in patients with clinically diagnosed progressive supranuclear palsy (PSP) and to establish the most accurate measure to be implemented in routine magnetic resonance (MR) protocol in distinguishing PSP from healthy subjects and MSA-p (multiple system atrophy, parkinsonian form) patients. MATERIALS AND METHODS We studied 15 patients with the diagnosis of probable PSP, seven patients with the diagnosis of probable MSA-p and 14 age-matched healthy volunteers. MR protocol includes a sagittal SE T1-weighted sequence for cross-sectional area and linear brainstem measurements and a 3D-FSPGR sequence for brainstem volume measurements. RESULTS A highly significant difference in the antero-posterior midbrain diameter, area and volume in PSP compared with control subjects was found. Only a measurement of the midbrain area and pons area enabled one to distinguish between PSP and MSA-p. Receiver operating characteristic analysis revealed that the midbrain area has the highest diagnostic accuracy in distinguishing between PSP and other conditions, with a sensitivity of 100% and specificity of 90.5%. The addition of the midbrain area/pons area ratio (A(ms)/A(pn) ratio) measurement improves the specificity in distinguishing between PSP and MSA. CONCLUSIONS Morphological indexes indicate midbrain atrophy in PSP patients The combination of the A(ms) and A(ms)/A(pn) ratio measurements allows to discriminate between PSP and other conditions.
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Affiliation(s)
- M Cosottini
- Department of Neuroscience, University of Pisa, Pisa, Italy.
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30
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Abstract
Progressive supranuclear palsy (PSP) is an atypical Parkinsonian disorder associated with progressive axial rigidity, vertical gaze palsy, dysarthria and dysphagia. Neuropathologically, the subthalamic nucleus and brainstem, especially the midbrain tectum and the superior cerebellar peduncle, show atrophy. The substantia nigra shows loss of pigment corresponding to nigrostriatal dopaminergic degeneration. Microscopic findings include neuronal loss, gliosis and neurofibrillary tangles in basal ganglia, diencephalon and brainstem. Characteristic tau pathology is also found in glia. The major genetic risk factor for sporadic PSP is a common variant in the gene encoding microtubule-associated protein tau (MAPT) and recent studies have suggested that this may result in the altered expression of specific tau protein isoforms. Imaging studies suggest that there may be sensitive and specific means to differentiate PSP from other parkinsonian disorders, but identification of a diagnostic biomarker is still elusive.
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Affiliation(s)
- Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA.
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31
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Swerdlow RH. Is aging part of Alzheimer's disease, or is Alzheimer's disease part of aging? Neurobiol Aging 2006; 28:1465-80. [PMID: 16876913 DOI: 10.1016/j.neurobiolaging.2006.06.021] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 06/05/2006] [Accepted: 06/22/2006] [Indexed: 01/11/2023]
Abstract
For 70 years after Alois Alzheimer described a disorder of tangle-and-plaque dementia, Alzheimer's disease was a condition of the relatively young. Definitions of Alzheimer's disease (AD) have, however, changed over the past 30 years and under the revised view AD has truly become an age-related disease. Most now diagnosed with AD are elderly and would not have been diagnosed with AD as originally conceived. Accordingly, younger patients that qualify for a diagnosis of AD under both original and current Alzheimer's disease constructs now represent an exceptionally small percentage of the diagnosed population. The question of whether pathogenesis of the "early" and "late" onset cases is similar enough to qualify as a single disease was previously raised although not conclusively settled. Interestingly, debate on this issue has not kept pace with advancing knowledge about the molecular, biochemical and clinical underpinnings of tangle-and-plaque dementias. Since the question of whether both forms of AD share a common pathogenesis could profoundly impact diagnostic and treatment development efforts, it seems worthwhile to revisit this debate.
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Affiliation(s)
- Russell H Swerdlow
- Department of Neurology, University of Virginia Health System, McKim Hall, 1 Hospital Drive, P.O. Box 800394, Charlottesville, VA 22908, United States.
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32
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Haouzi P, Chenuel B, Barroche G. Interactions between volitional and automatic breathing during respiratory apraxia. Respir Physiol Neurobiol 2006; 152:169-75. [PMID: 16185939 DOI: 10.1016/j.resp.2005.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Revised: 08/06/2005] [Accepted: 08/08/2005] [Indexed: 11/15/2022]
Abstract
The sites and forms of interactions between voluntary breathing acts and automatic respiratory rhythm generation are the subject of considerable research interest. We report here observations of the control of breathing in a patient suffering from an advanced form of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome). This patient demonstrated a severely compromised ability to perform volitional respiratory acts upon command, despite exacerbated behavioural and automatic control of respiration. The presence of residual volitional control of breathing in this patient provided interesting insights concerning the interaction between the automatic and the voluntary control of respiration. We observed that (1) when the subjects was asked to inspire voluntarily he could at best mobilize a volume similar to spontaneous VT and only very slowly; (2) automatic breathing movements persisted, superimposed onto the active voluntary movements, with an amplitude that decreased when the inspiratory activity, albeit weak, reached its maximal level; (3) during breath holding both the amplitude and the frequency of the basal spontaneous rhythmic activity were depressed. This observation therefore supports the idea of a strong interaction between volitional and automatic breathing in the form of an inhibition of automatic activity during voluntary breathing. Although, the site of interaction (spinal versus supraspinal) could not be determined during volitional inspiration, the effect of breath holding on the frequency of the spontaneous breathing activity supports the view that a volitional breathing arrest has some inhibitory effects on the respiratory oscillator at the medullary level. Finally, in an attempt to reconcile the persistence of a rhythmic activity during voluntary inspiration and expiration with previous data from the literature, it is proposed that the normal suppression of the automatic activity during voluntary inspiration relies on cortical and sub-cortical structures involved in the planning, i.e. the praxic component, of a respiratory task rather than on projections originating from the primary motor cortex.
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Affiliation(s)
- Philippe Haouzi
- Laboratoire de Physiologie, Faculté de Médecine de Nancy, Service d'Exploration Fonctionnelle Respiratoire, Vandoeuvre-lès-Nancy, France.
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33
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Keyserling H, Mukundan S. The Role of Conventional MR and CT in the Work-Up of Dementia Patients. Magn Reson Imaging Clin N Am 2006; 14:169-82. [PMID: 16873009 DOI: 10.1016/j.mric.2006.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Dementia is a clinical syndrome with many causes. There often is overlap in the clinical manifestations of various forms of dementia, making them difficult to categorize. Neuroimaging can play an important role in distinguishing one form of dementia from another. Advanced imaging techniques continue to provide greater insight into the underlying pathologic processes in patients who have dementia. Conventional MRI and CT, however, still can contribute useful information when interpreting radiologists are familiar with the patterns of volume loss and signal or density changes that are characteristic of various forms of dementia.
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Affiliation(s)
- Harold Keyserling
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
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34
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Keyserling H, Mukundan S. The role of conventional MR and CT in the work-up of dementia patients. Neuroimaging Clin N Am 2006; 15:789-802, x. [PMID: 16443491 DOI: 10.1016/j.nic.2005.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neuroimaging can play an important role in distinguishing one form of dementia from another. Advanced imaging techniques continue to provide greater insight into the underlying pathologic processes in patients who have dementia. Conventional MRI and CT, however, can contribute useful information when interpreting radiologists are familiar with the patterns of volume loss and signal or density changes that are characteristic of various forms of dementia.
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Affiliation(s)
- Harold Keyserling
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
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35
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Abstract
The correct diagnosis of Parkinson's disease is important for prognostic and therapeutic reasons and is essential for clinical research. Investigations of the diagnostic accuracy for the disease and other forms of parkinsonism in community-based samples of patients taking antiparkinsonian medication confirmed a diagnosis of parkinsonism in only 74% of patients and clinically probable Parkinson's disease in 53% of patients. Clinicopathological studies based on brain bank material from the UK and Canada have shown that clinicians diagnose the disease incorrectly in about 25% of patients. In these studies, the most common reasons for misdiagnosis were presence of essential tremor, vascular parkinsonism, and atypical parkinsonian syndromes. Infrequent diagnostic errors included Alzheimer's disease, dementia with Lewy bodies, and drug-induced parkinsonism. Increasing knowledge of the heterogeneous clinical presentation of the various parkinsonisms has resulted in improved diagnostic accuracy of the various parkinsonian syndromes in specialised movement-disorder units. Also genetic testing and various other ancillary tests, such as olfactory testing, MRI, and dopamine-transporter single-photon-emission computed-tomography imaging, help with clinical diagnostic decisions.
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Affiliation(s)
- Eduardo Tolosa
- Neurology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain.
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36
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Kugaya A, Chiles C. Psychiatric symptoms in progressive supranuclear palsy. Gen Hosp Psychiatry 2006; 28:80-1. [PMID: 16377371 DOI: 10.1016/j.genhosppsych.2005.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2005] [Revised: 07/03/2005] [Accepted: 08/05/2005] [Indexed: 11/23/2022]
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37
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Rampello L, Buttà V, Raffaele R, Vecchio I, Battaglia G, Cormaci G, Alvano A. Progressive supranuclear palsy: A systematic review. Neurobiol Dis 2005; 20:179-86. [PMID: 16242626 DOI: 10.1016/j.nbd.2005.03.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Revised: 01/21/2005] [Accepted: 03/18/2005] [Indexed: 11/25/2022] Open
Abstract
The progressive supranuclear palsy (PSP) is a rapidly progressing degenerative disease belonging to the family of tauophaties, characterized by the involvement of both cortical and subcortical structures. Although the pathogenesis of PSP is still uncertain, genetic, biochemical, and immunohistochemical studies have been performed and are reviewed here. Genetic factors, oxidative damage, neurotoxins, and environmental factors contribute to tau deposition in the cerebral areas involved in PSP. Symptoms originate from the ensuing dysfunction of dopaminergic, GABAergic, cholinergic, and noradrenergic pathways. Recent advances in neuroradiological and instrumental examinations facilitate the diagnosis and have gained new insights into the pathophysiology of PSP, although the primary cause of the disease is unknown and disease-modifying drugs are not yet available.
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Affiliation(s)
- L Rampello
- Department of Neurosciences, University of Catania, Azienda Policlinico-Neurologia, via S. Sofia, 78, 95125 Catania, Italy.
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Höglinger GU, Lannuzel A, Khondiker ME, Michel PP, Duyckaerts C, Féger J, Champy P, Prigent A, Medja F, Lombes A, Oertel WH, Ruberg M, Hirsch EC. The mitochondrial complex I inhibitor rotenone triggers a cerebral tauopathy. J Neurochem 2005; 95:930-9. [PMID: 16219024 DOI: 10.1111/j.1471-4159.2005.03493.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Reduced activity of the mitochondrial respiratory chain--particularly complex I--may be implicated in the etiology of both Parkinson's disease and progressive supranuclear palsy, although these neurodegenerative diseases differ substantially as to their distinctive pattern of neuronal cell loss and the predominance of cerebral alpha-synuclein or tau protein pathology. To determine experimentally whether chronic generalized complex I inhibition has an effect on the distribution of alpha-synuclein or tau, we infused rats systemically with the plant-derived isoflavonoid rotenone. Rotenone-treated rats with a pronounced metabolic impairment had reduced locomotor activity, dystonic limb posture and postural instability. They lost neurons in the substantia nigra and in the striatum. Spherical deposits of alpha-synuclein were observed in a few cells, but cells with abnormal cytoplasmic accumulations of tau immunoreactivity were significantly more numerous in the striatum of severely lesioned rats. Abnormally high levels of tau immunoreactivity were found in the cytoplasm of neurons, oligodendrocytes and astrocytes. Ultrastructurally, tau-immunoreactive material consisted of straight 15-nm filaments decorated by antibodies against phosphorylated tau. Many tau+ cell bodies also stained positive for thioflavin S, nitrotyrosine and ubiquitin. Some cells with abnormal tau immunoreactivity contained activated caspase 3. Our data suggest that chronic respiratory chain dysfunction might trigger a form of neurodegeneration in which accumulation of hyperphosphorylated tau protein predominates over deposits of alpha-synuclein.
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39
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Juh R, Pae CU, Kim TS, Lee CU, Choe B, Suh T. Cerebral glucose metabolism in corticobasal degeneration comparison with progressive supranuclear palsy using statistical mapping analysis. Neurosci Lett 2005; 383:22-7. [PMID: 15936506 DOI: 10.1016/j.neulet.2005.03.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Revised: 03/18/2005] [Accepted: 03/21/2005] [Indexed: 10/25/2022]
Abstract
This study measured the cerebral glucose metabolism in patients suffering from corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP). The aim was to determine if there is a different metabolic pattern using (18)F-labeled 2-deoxyglucose ((18)F-FDG) positron emission tomography (PET). The regional cerebral glucose metabolism was examined in 8 patients diagnosed clinically with CBD (mean age 69.6 +/- 7.8 years; male/female: 5/3), 8 patients with probable PSP (mean age 67.8 +/- 4.5 years; male/female: 4/4) and 22 healthy controls. The regional cerebral glucose metabolism between the three groups was compared using statistical parametric mapping (SPM) with a voxel-by-voxel approach (p < 0.001, 200-voxel level). Compared with the normal controls, asymmetry in the regional glucose metabolism was observed in the parietal, frontal and cingulate in the CBD patients. In the PSP patients, the glucose metabolism was lower in the orbitofrontal, middle frontal, cingulate, thalamus and mid-brain than their age matched normal controls. A comparison of the two patient groups demonstrated relative hypometabolism in the thalamus, the mid-brain in the PSP patients and the parietal lobe in CBD patients. These results suggest that when making a differential diagnosis of CBD and PSP, voxel-based analysis of the (18)F-FDG PET images using a SPM might be a useful tool in clinical examinations.
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Affiliation(s)
- Rahyeong Juh
- Department of Biomedical Engineering, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seocho-Gu, Seoul
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