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Buawangpong N, Phinyo P, Angkurawaranon C, Soontornpun A, Jiraporncharoen W, Sirikul W, Pinyopornpanish K. External Validation of the Charlson Comorbidity Index-based Model for Survival Prediction in Thai Patients Diagnosed with Dementia. BMC Geriatr 2024; 24:675. [PMID: 39134981 PMCID: PMC11318235 DOI: 10.1186/s12877-024-05238-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The Charlson Comorbidity Index (CCI) is commonly employed for predicting mortality. Nonetheless, its performance has rarely been evaluated in patients with dementia. This study aimed to examine the predictive capability of the CCI-based model for survival prediction in Thai patients diagnosed with dementia. METHODS An external validation study was conducted using retrospective data from adults with dementia who had visited the outpatient departments at Maharaj Nakorn Chiang Mai Hospital between 2006 and 2012. The data obtained from electronic medical records included age, gender, date of dementia diagnosis and death, types of dementia, and comorbidities at the time of dementia diagnosis. The discriminative ability and calibration of the CCI-based model were estimated using Harrell's C Discrimination Index and visualized with calibration plot. As the initial performance did not meet satisfaction, model updating and recalibration were performed. RESULTS Of 702 patients, 56.9% were female. The mean age at dementia diagnosis was 75.22 (SD 9.75) year-old. During external validation, Harrell's C-statistic of the CCI-based model was 0.58 (95% CI, 0.54-0.61). The model showed poor external calibration. Model updating was subsequently performed. All updated models demonstrated a modest increase in Harrell's C-statistic. Temporal recalibration did not significantly improve the calibration of any of the updated models. CONCLUSION The CCI-based model exhibited fair discriminative ability and poor calibration for predicting survival in Thai patients diagnosed with dementia. Despite attempts at model updating, significant improvements were not achieved. Therefore, it is important to consider the incorporation of other influential prognostic factors.
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Affiliation(s)
- Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Chiang Mai, 50200, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Atiwat Soontornpun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Chiang Mai, 50200, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Wachiranun Sirikul
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Chiang Mai, 50200, Thailand.
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Msika EF, Despres M, Piolino P, Narme P. Dynamic and/or multimodal assessments for social cognition in neuropsychology: Results from a systematic literature review. Clin Neuropsychol 2024; 38:922-962. [PMID: 37904259 DOI: 10.1080/13854046.2023.2266172] [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: 03/21/2023] [Accepted: 09/27/2023] [Indexed: 11/01/2023]
Abstract
Objective: Despite the prevalence of socio-cognitive disturbances, and their important diagnostic/therapeutic implications, the assessment of these disturbances remains scarce. This systematic review aims to identify available social cognition tools for adult assessment that use multimodal and/or dynamic social cues, specifying their strengths and limitations (e.g. from a methodological, psychometric, ecological, and clinical perspective). Method: An electronic search was conducted in Pubmed, PsychINFO, Embase and Scopus databases for articles published up to the 3th of January 2023 and the first 200 Google Scholar results on the same date. The PRISMA methodology was applied, 3884 studies were screened based on title and abstract and 329 full texts were screened. Articles using pseudo-dynamic methodologies (e.g. morphing), reported only subjective or self-reported measures, or investigated only physiological or brain activity responses were excluded. Results: In total, 149 works were included in this review, representing 65 assessment tools (i.e. 48% studying emotion recognition (n = 31), 32% Theory of Mind (n = 21), 5% empathy (n = 3), 1.5% moral cognition/social reasoning (n = 1), and 14% being multimodal (n = 9)). For each study, the tool's main characteristics, psychometric properties, ecological validity indicators and available norms are reported. The tools are presented according to social-cognitive process assessed and communication channels used. Conclusions: This study highlights the lack of validated and standardized tools. A few tools appear to partially meet some clinical needs. The development of methodologies using a first-person paradigm and taking into account the multidimensional nature of social cognition seems a relevant research endeavour for greater ecological validity.
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Affiliation(s)
- Eva-Flore Msika
- Laboratoire Mémoire, Cerveau et Cognition, Université Paris Cité, Boulogne-Billancourt, France
| | - Mathilde Despres
- Laboratoire Mémoire, Cerveau et Cognition, Université Paris Cité, Boulogne-Billancourt, France
| | - Pascale Piolino
- Laboratoire Mémoire, Cerveau et Cognition, Université Paris Cité, Boulogne-Billancourt, France
| | - Pauline Narme
- Laboratoire Mémoire, Cerveau et Cognition, Université Paris Cité, Boulogne-Billancourt, France
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Burgio MI, Veronese N, Sarà D, Saccaro C, Masnata R, Vassallo G, Catania A, Catanese G, Mueller C, Smith L, Dominguez LJ, Vernuccio L, Barbagallo M. Markers for the detection of Lewy body disease versus Alzheimer's disease in mild cognitive impairment: a systematic review and meta-analysis. Aging Clin Exp Res 2024; 36:60. [PMID: 38451331 PMCID: PMC10920203 DOI: 10.1007/s40520-024-02704-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/17/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Mild cognitive impairment (MCI) may evolve into dementia. Early recognition of possible evolution to Alzheimer's disease (AD) and dementia with Lewy Bodies (DLB) is of importance, but actual diagnostic criteria have some limitations. In this systematic review and meta-analysis, we aimed to find the most accurate markers that can discriminate patients with DLB versus AD, in MCI stage. METHODS We searched several databases up to 17 August 2023 including studies comparing markers that may distinguish DLB-MCI from AD-MCI. We reported data regarding sensitivity, specificity, and the area under the curves (AUCs) with their 95% confidence intervals (CIs). RESULTS Among 2219 articles initially screened, eight case-control studies and one cohort study were included for a total of 832 outpatients with MCI. The accuracy of cerebrospinal fluid (CSF) markers was the highest among the markers considered (AUC > 0.90 for the CSF markers), with the AUC of CSF Aβ42/Aβ40 of 0.94. The accuracy for clinical symptom scales was very good (AUC = 0.93), as evaluated in three studies. Although limited to one study, the accuracy of FDG-PET (cingulate island sign ratio) was very good (AUC = 0.95) in discriminating DLB from AD in MCI, while the accuracy of SPECT markers and EEG frequencies was variable. CONCLUSIONS Few studies have assessed the accuracy of biomarkers and clinical tools to distinguish DLB from AD at the MCI stage. While results are promising for CSF markers, FDG-PET and clinical symptoms scales, more studies, particularly with a prospective design, are needed to evaluate their accuracy and clinical usefulness. CLINICAL TRIAL REGISTRATION Prospero (CRD42023422600).
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Affiliation(s)
- Marianna Ilarj Burgio
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Nicola Veronese
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy.
| | - Davide Sarà
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Carlo Saccaro
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Roberta Masnata
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Giusy Vassallo
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Angela Catania
- International School of Advanced Studies, University of Camerino, Camerino, Italy
| | - Giuseppina Catanese
- Geriatric Unit, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Christoph Mueller
- South London and Maudsley National Health Service Foundation Trust, London, UK
- Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Ligia Juliana Dominguez
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Laura Vernuccio
- Geriatric Unit, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Mario Barbagallo
- Department of Health Promotion, Mother Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
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Jreige M, Kurian GK, Perriraz J, Potheegadoo J, Bernasconi F, Stampacchia S, Blanke O, Alessandra G, Lejay N, Chiabotti PS, Rouaud O, Nicod Lalonde M, Schaefer N, Treglia G, Allali G, Prior JO. The diagnostic performance of functional dopaminergic scintigraphic imaging in the diagnosis of dementia with Lewy bodies: an updated systematic review. Eur J Nucl Med Mol Imaging 2023; 50:1988-2035. [PMID: 36920494 PMCID: PMC10199865 DOI: 10.1007/s00259-023-06154-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/13/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Dopaminergic scintigraphic imaging is a cornerstone to support the diagnosis in dementia with Lewy bodies. To clarify the current state of knowledge on this imaging modality and its impact on clinical diagnosis, we performed an updated systematic review of the literature. METHODS This systematic review was carried out according to PRISMA guidelines. A comprehensive computer literature search of PubMed/MEDLINE, EMBASE, and Cochrane Library databases for studies published through June 2022 was performed using the following search algorithm: (a) "Lewy body" [TI] OR "Lewy bodies" [TI] and (b) ("DaTscan" OR "ioflupane" OR "123ip" OR "123?ip" OR "123 ip" OR "123i-FP-CIT" OR "FPCIT" OR "FP-CIT" OR "beta?CIT" OR "beta CIT" OR "CIT?SPECT" OR "CIT SPECT" OR "Dat?scan*" OR "dat scan*" OR "dat?spect*" OR "SPECT"). Risk of bias and applicability concerns of the studies were evaluated using the QUADAS-2 tool. RESULTS We performed a qualitative analysis of 59 studies. Of the 59 studies, 19 (32%) addressed the diagnostic performance of dopamine transporter imaging, 15 (25%) assessed the identification of dementia with Lewy bodies in the spectrum of Lewy body disease and 18 (31%) investigated the role of functional dopaminergic imaging in distinguishing dementia with Lewy bodies from other dementias. Dopamine transporter loss was correlated with clinical outcomes in 19 studies (32%) and with other functional imaging modalities in 15 studies (25%). Heterogeneous technical aspects were found among the studies through the use of various radioligands, the more prevalent being the [123I]N‑ω‑fluoropropyl‑2β‑carbomethoxy‑3β‑(4‑iodophenyl) nortropane (123I-FP-CIT) in 54 studies (91.5%). Image analysis used visual analysis (9 studies, 15%), semi-quantitative analysis (29 studies, 49%), or a combination of both (16 studies, 27%). CONCLUSION Our systematic review confirms the major role of dopaminergic scintigraphic imaging in the assessment of dementia with Lewy bodies. Early diagnosis could be facilitated by identifying the prodromes of dementia with Lewy bodies using dopaminergic scintigraphic imaging coupled with emphasis on clinical neuropsychiatric symptoms. Most published studies use a semi-quantitative analytical assessment of tracer uptake, while there are no studies using quantitative analytical methods to measure dopamine transporter loss. The superiority of a purely quantitative approach to assess dopaminergic transmission more accurately needs to be further clarified.
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Affiliation(s)
- Mario Jreige
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - George K Kurian
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Jérémy Perriraz
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jevita Potheegadoo
- Laboratory of Cognitive Neuroscience, Neuro-X Institute & Brain Mind Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Fosco Bernasconi
- Laboratory of Cognitive Neuroscience, Neuro-X Institute & Brain Mind Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Sara Stampacchia
- Laboratory of Cognitive Neuroscience, Neuro-X Institute & Brain Mind Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Neuro-X Institute & Brain Mind Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Griffa Alessandra
- Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Noemie Lejay
- Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Paolo Salvioni Chiabotti
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Rouaud
- Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie Nicod Lalonde
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Giorgio Treglia
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Gilles Allali
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
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Müller SJ, Khadhraoui E, Hansen N, Jamous A, Langer P, Wiltfang J, Riedel CH, Bouter C, van Riesen C, Maass F, Bartl M, Lange C, Ernst M. Brainstem atrophy in dementia with Lewy bodies compared with progressive supranuclear palsy and Parkinson's disease on MRI. BMC Neurol 2023; 23:114. [PMID: 36944914 PMCID: PMC10029226 DOI: 10.1186/s12883-023-03151-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Although Dementia with Lewy bodies (DLB) is the second most common form of dementia in elderly patients, it remains underdiagnosed compared with Alzheimer's (AD) and Parkinson's diseases (PD). This may be explained by overlapping clinical symptoms, e.g. Parkinsonism. While current MRI research focuses primarily on atrophy patterns of the frontal and temporal lobes, we focus on brainstem characteristics of DLB. In particular, we focused on brainstem atrophy patterns distinguishing DLB from Progressive Supranuclear Palsy (PSP) and PD based as the most common differential diagnoses. METHODS We identified patients diagnosed with DLB, PD, PSP, and a control group (CTRL) in our psychiatric and neurological archives. All patients with competing diagnoses and without a high-quality T1 MPRAGE 3D dataset were excluded. We assessed atrophy patterns in all patients (1) manually and (2) using FastSurfer's segmentation algorithm in combination with FreeSurfer's brainstem volumetric calculations. We compared classical measurement methods and ratios with automated volumetric approaches. RESULTS One hundred two patients were enrolled and evaluated in this study. Patients with DLB (n = 37) showed on average less atrophy of the brainstem than patients with PSP (n = 21), but a significantly more pronounced atrophy than patients with PD (n = 36) and the control group (CTRL, n = 8). The mean measured sagittal diameters of the midbrain were 8.17 ± 1.06 mm (mean ± standard deviation) for PSP, 9.45 ± 0.95 mm for DLB, 10.37 ± 0.99 mm for PD and 10.74 ± 0.70 for CTRL. The mean measured areas of the midbrain were 81 ± 18 mm2 for PSP, 105 ± 17 mm2 for DLB, 130 ± 26 mm2 for PD and 135 ± 23 mm2 for CTRL. The mean segmented volumes of the midbrain were 5595 ± 680 mm3 for PSP, 6051 ± 566 mm3 for DLB, 6646 ± 802 mm3 for PD and 6882 ± 844 mm3 for CTRL. The calculated midbrain pons ratios did not show superiority over the absolute measurements of the midbrain for distinguishing PSP from DLB. Because of the relatively uniform atrophy throughout the brainstem, the ratios were not suitable for distinguishing DLB from PD. CONCLUSIONS DLB patients exhibit homogenous atrophy of the brainstem and can be distinguished from patients with PSP and PD by both manual measurement methods and automated volume segmentation using absolute values or ratios.
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Affiliation(s)
- Sebastian Johannes Müller
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Eya Khadhraoui
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Niels Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Ala Jamous
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Philip Langer
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Medical Sciences, Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Christian Heiner Riedel
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Caroline Bouter
- Department of Nuclear Medicine, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Christoph van Riesen
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Neurology, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Fabian Maass
- Department of Neurology, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Michael Bartl
- Department of Neurology, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Claudia Lange
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Georg-August-University, Göttingen, Germany
| | - Marielle Ernst
- Institute of Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen (UMG), Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Buawangpong N, Pinyopornpanish K, Phinyo P, Jiraporncharoen W, Angkurawaranon C, Soontornpun A. Effect of Comorbidities on Ten-Year Survival in Patients with Dementia. J Alzheimers Dis 2023; 94:163-175. [PMID: 37212105 DOI: 10.3233/jad-221259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND There is a verified association between comorbidity and survival in patients with dementia. OBJECTIVE To describe the ten-year survival probability of patients with dementia and to identify the impact of comorbidity. METHODS The prognostic retrospective cohort study was conducted using data from adults with dementia who had visited the outpatient departments at Maharaj Nakorn Chiang Mai hospital between 2006 and 2012. Dementia was verified in accordance with standard practice guidelines. Secondary data detailing about patient age, gender, date of dementia diagnosis and death, types of dementia, and comorbidities at the time of dementia diagnosis was obtained from electronic medical records. The association between comorbidity, patients' underlying disease at dementia diagnosis, and overall survival were analyzed using a multivariable Cox proportional hazard model adjusted for age, gender, types of dementia, and other comorbidities. RESULTS Of the 702 patients, 56.9% were female. Alzheimer's disease (39.6%) was the most prevalent type of dementia. Median overall survival was 6.0 years (95% CI 5.5- 6.7). The comorbidities associated with a high risk of mortality included liver disease (aHR 2.70, 95% CI 1.46- 5.00), atrial fibrillation (aHR 2.15, 95% CI 1.29- 3.58), myocardial infarction (aHR 1.55, 95% CI 1.07- 2.26), and type 2 diabetes mellitus (aHR 1.40, 95% CI 1.13- 1.74). CONCLUSION Overall survival rate of patients with dementia in Thailand was comparable to previous studies. Several comorbidities were associated with a ten-year survival. The prognosis of patients with dementia may be improved by appropriate care of comorbidities.
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Affiliation(s)
- Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand
| | - Atiwat Soontornpun
- Department of Internal Medicine, Division of Neurology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Zhu CW, Gu Y, Kociolek AJ, Fernandez KK, Cosentino S, Stern Y. Costs During the Last Five Years of Life for Patients with Clinical and Pathological Confirmed Diagnosis of Lewy Body Dementia and Alzheimer's Disease. J Alzheimers Dis 2023; 92:457-466. [PMID: 36776064 PMCID: PMC10120914 DOI: 10.3233/jad-221021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Little is known regarding healthcare expenditures for patients with dementia with Lewy bodies (DLB) during the end of life. OBJECTIVE This study estimated Medicare expenditures during the last 5 years of life in a decedent sample of patients who were clinically diagnosed with Alzheimer's disease (AD) or DLB and had autopsy confirmed diagnosis. METHODS The study included 58 participants clinically diagnosed with mild dementia at study entry (AD: n = 44, DLB: n = 14) and also had autopsy-confirmed diagnoses of pure AD (n = 32), mixed AD+Lewy body (LB) (n = 5), or pure LB (n = 11). Total Medicare expenditures were compared by clinical and pathology confirmed diagnosis, adjusting for sex, age at death, and patient's cognition, function, comorbidities, and psychiatric and extrapyramidal symptoms. RESULTS When pathology diagnoses were not considered, predicted annualized total Medicare expenditures during the last 5 years of life were similar between clinically diagnosed AD ($7,465±1,098) and DLB ($7,783±1,803). When clinical diagnoses were not considered, predicted expenditures were substantially higher in patients with pathology confirmed mixed AD+LB ($12,005±2,455) than either pure AD ($6,173±941) or pure LB ($4,629±1,968) cases. Considering clinical and pathology diagnosis together, expenditures for patients with clinical DLB and pathology mixed AD+LB ($23,592±3,679) dwarfed other groups. CONCLUSION Medicare expenditures during the last 5 years of life were substantially higher in patients with mixed AD+LB pathology compared to those with pure-AD and pure-LB pathologies, particularly in those clinically diagnosed with DLB. Results highlight the importance of having both clinical and pathology diagnoses in examining healthcare costs.
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Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J Peters VA Medical Center, Bronx, NY, USA
| | - Yian Gu
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Anton J. Kociolek
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Kayri K. Fernandez
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephanie Cosentino
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Yaakov Stern
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Taub Institute for Research in Alzheimer’s Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
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Lysophospholipids: A Potential Drug Candidates for Neurodegenerative Disorders. Biomedicines 2022; 10:biomedicines10123126. [PMID: 36551882 PMCID: PMC9775253 DOI: 10.3390/biomedicines10123126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Neurodegenerative diseases (NDs) commonly present misfolded and aggregated proteins. Considerable research has been performed to unearth the molecular processes underpinning this pathological aggregation and develop therapeutic strategies targeting NDs. Fibrillary deposits of α-synuclein (α-Syn), a highly conserved and thermostable protein, are a critical feature in the development of NDs such as Alzheimer's disease (AD), Lewy body disease (LBD), Parkinson's disease (PD), and multiple system atrophy (MSA). Inhibition of α-Syn aggregation can thus serve as a potential approach for therapeutic intervention. Recently, the degradation of target proteins by small molecules has emerged as a new therapeutic modality, gaining the hotspot in pharmaceutical research. Additionally, interest is growing in the use of food-derived bioactive compounds as intervention agents against NDs via functional foods and dietary supplements. According to reports, dietary bioactive phospholipids may have cognition-enhancing and neuroprotective effects, owing to their abilities to influence cognition and mental health in vivo and in vitro. However, the mechanisms by which lipids may prevent the pathological aggregation of α-Syn warrant further clarification. Here, we review evidence for the potential mechanisms underlying this effect, with a particular focus on how porcine liver decomposition product (PLDP)-derived lysophospholipids (LPLs) may inhibit α-Syn aggregation.
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9
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Pavel DG, Henderson TA, DeBruin S, Cohen PF. The Legacy of the TTASAAN Report - Premature Conclusions and Forgotten Promises About SPECT Neuroimaging: A Review of Policy and Practice Part II. Front Neurol 2022; 13:851609. [PMID: 35655621 PMCID: PMC9152128 DOI: 10.3389/fneur.2022.851609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970s. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was not stabilized until 1993 and most early SPECT scans were performed on single-head gamma cameras. These early scans were of inferior quality. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. This two-part series explores the policies and procedures related to perfusion SPECT functional neuroimaging. In Part I, the comparison between the quality of the SPECT scans and the depth of the data for key neurological and psychiatric indications at the time of the TTASAAN report vs. the intervening 25 years were presented. In Part II, the technical aspects of perfusion SPECT neuroimaging and image processing will be explored. The role of color scales will be reviewed and the process of interpreting a SPECT scan will be presented. Interpretation of a functional brain scans requires not only anatomical knowledge, but also technical understanding on correctly performing a scan, regardless of the scanning modality. Awareness of technical limitations allows the clinician to properly interpret a functional brain scan. With this foundation, four scenarios in which perfusion SPECT neuroimaging, together with other imaging modalities and testing, lead to a narrowing of the differential diagnoses and better treatment. Lastly, recommendations for the revision of current policies and practices are made.
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Affiliation(s)
- Dan G Pavel
- PathFinder Brain SPECT, Deerfield, IL, United States.,The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States
| | - Theodore A Henderson
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States.,Neuro-Laser Foundation, Denver, CO, United States
| | - Simon DeBruin
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Good Lion Imaging, Baltimore, MD, United States
| | - Philip F Cohen
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Nuclear Medicine, Lions Gate Hospital, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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10
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Chen YT, Orimo S, Wei CY, Hung GU, Yang SY, Chiu PY. Synuclein Motor Dysfunction Composite Scale for the Discrimination of Dementia With Lewy Bodies From Alzheimer’s Disease. Front Aging Neurosci 2022; 14:920591. [PMID: 35663565 PMCID: PMC9161692 DOI: 10.3389/fnagi.2022.920591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background An abnormal increase of α-synuclein in the brain is the hallmark of dementia with Lewy bodies (DLB). However, the diagnostic power of plasma α-synuclein in DLB is not yet confirmed. Parkinsonism is highly associated with and is one of the core clinical features of DLB. We studied plasma α-synuclein and developed a novel tool that combined plasma α-synuclein level and Motor Dysfunction Questionnaire (MDQ), namely Synuclein Motor Dysfunction Composite Scale (SMDCS), for the clinical discrimination of DLB from Alzheimer’s disease (AD). Methods This cross-sectional study analyzed participants’ demographical data, plasma α-synuclein level, MDQ, structured clinical history questionnaire, neuropsychological and motor function tests, and neuroimaging studies. The power of plasma α-synuclein level, MDQ, and SMDCS for discriminating DLB from non-demented controls (NC) or AD were compared. Results Overall, 121 participants diagnosed as 58 DLB, 31 AD, and 31 NC were enrolled. Patients with DLB had significantly higher mean plasma α-synuclein level (0.24 ± 0.32 pg/ml) compared to the NC group (0.08 ± 0.05 pg/ml) and the AD group (0.08 ± 0.05 pg/ml). The DLB group demonstrated higher MDQ (2.95 ± 1.60) compared to the NC (0.42 ± 0.98) or AD (0.44 ± 0.99) groups. The sensitivity/specificity of plasma α-synuclein level, MDQ, and SMDCS for differentiating DLB from non-DLB were 0.80/0.64, 0.83/0.89, and 0.88/0.93, respectively. Conclusion Both plasma α-synuclein and MDQ were significantly higher in patients with DLB compared to the NC or AD groups. The novel SMDCS, significantly improved accuracy for the clinical differentiation of DLB from AD or NC.
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Affiliation(s)
- Ying-Tsung Chen
- Department of Psychiatry, Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Psychiatry, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Satoshi Orimo
- Department of Neurology, Kamiyoga Setagaya Street Clinic, Tokyo, Japan
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | | | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Applied Mathematics, Tunghai University, Taichung, Taiwan
- *Correspondence: Pai-Yi Chiu,
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11
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Henríquez F, Cabello V, Baez S, de Souza LC, Lillo P, Martínez-Pernía D, Olavarría L, Torralva T, Slachevsky A. Multidimensional Clinical Assessment in Frontotemporal Dementia and Its Spectrum in Latin America and the Caribbean: A Narrative Review and a Glance at Future Challenges. Front Neurol 2022; 12:768591. [PMID: 35250791 PMCID: PMC8890568 DOI: 10.3389/fneur.2021.768591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
Frontotemporal dementia (FTD) is the third most common form of dementia across all age groups and is a leading cause of early-onset dementia. The Frontotemporal dementia (FTD) includes a spectrum of diseases that are classified according to their clinical presentation and patterns of neurodegeneration. There are two main types of FTD: behavioral FTD variant (bvFTD), characterized by a deterioration in social function, behavior, and personality; and primary progressive aphasias (PPA), characterized by a deficit in language skills. There are other types of FTD-related disorders that present motor impairment and/or parkinsonism, including FTD with motor neuron disease (FTD-MND), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS). The FTD and its associated disorders present great clinical heterogeneity. The diagnosis of FTD is based on the identification through clinical assessments of a specific clinical phenotype of impairments in different domains, complemented by an evaluation through instruments, i.e., tests and questionnaires, validated for the population under study, thus, achieving timely detection and treatment. While the prevalence of dementia in Latin America and the Caribbean (LAC) is increasing rapidly, there is still a lack of standardized instruments and consensus for FTD diagnosis. In this context, it is important to review the published tests and questionnaires adapted and/or validated in LAC for the assessment of cognition, behavior, functionality, and gait in FTD and its spectrum. Therefore, our paper has three main goals. First, to present a narrative review of the main tests and questionnaires published in LAC for the assessment of FTD and its spectrum in six dimensions: (i) Cognitive screening; (ii) Neuropsychological assessment divided by cognitive domain; (iii) Gait assessment; (iv) Behavioral and neuropsychiatric symptoms; (v) Functional assessment; and (vi) Global Rating Scale. Second, to propose a multidimensional clinical assessment of FTD in LAC identifying the main gaps. Lastly, it is proposed to create a LAC consortium that will discuss strategies to address the current challenges in the field.
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Affiliation(s)
- Fernando Henríquez
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Laboratory for Cognitive and Evolutionary Neuroscience (LaNCE), Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Victoria Cabello
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sandra Baez
- Universidad de los Andes, Departamento de Psicología, Bogotá, Colombia
| | - Leonardo Cruz de Souza
- Programa de Pós-Graduação em Neurociências da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Patricia Lillo
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Unidad de Neurología, Hospital San José, Santiago, Chile
| | - David Martínez-Pernía
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Loreto Olavarría
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Teresa Torralva
- Institute of Cognitive and Translational Neuroscience (INCYT), Instituto de Neurología Cognitiva Foundation, Favaloro University, Buenos Aires, Argentina
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Neurology and Psychiatry, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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12
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Cervantes González A, Belbin O. Fluid markers of synapse degeneration in synucleinopathies. J Neural Transm (Vienna) 2022; 129:187-206. [PMID: 35147800 DOI: 10.1007/s00702-022-02467-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/20/2022] [Indexed: 01/06/2023]
Abstract
The abnormal accumulation of α-synuclein in the brain is a common feature of Parkinson's disease (PD), PD dementia (PDD), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA), and synucleinopathies that present with overlapping but distinct clinical symptoms that include motor and cognitive deficits. Synapse degeneration is the crucial neuropathological event in these synucleinopathies and the neuropathological correlate of connectome dysfunction. The cognitive and motor deficits resulting from the connectome dysfunction are currently measured by scalar systems that are limited in their sensitivity and largely subjective. Ideally, a marker of synapse degeneration would correlate with measures of cognitive or motor impairment, and could therefore be used as a more objective, surrogate biomarker of the core clinical features of these diseases. Furthermore, an objective surrogate biomarker that can detect and monitor the progression of synapse degeneration would improve patient management and clinical trial design, and could provide a measure of therapeutic response. Here, we review the published findings relating to candidate biomarkers of synapse degeneration in PD, PDD, DLB, and MSA patient-derived biofluids and discuss the findings in the context of the mechanisms associated with α-synuclein-mediated synapse degeneration. Understanding these mechanisms is essential not only for discovery of biomarkers, but also to improve our understanding of the earliest changes in disease pathogenesis of synucleinopathies.
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Affiliation(s)
- Alba Cervantes González
- Neurology Department, Biomedical Research Institute Sant Pau (IIB Sant Pau) and Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - Olivia Belbin
- Neurology Department, Biomedical Research Institute Sant Pau (IIB Sant Pau) and Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau, 08025, Barcelona, Spain.
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain.
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13
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Peles PRH, Salvador LDS, Souza LCD, Caramelli P. Accuracy of the Brief Cognitive Screening Battery for diagnosing Alzheimer's disease defined by cerebrospinal fluid biomarkers and AT(N) classification: a case-control study. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 80:23-29. [PMID: 34816970 PMCID: PMC9651505 DOI: 10.1590/0004-282x-anp-2021-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Validation of cognitive instruments for detection of Alzheimer's disease (AD) based on correlation with diagnostic biomarkers allows more reliable identification of the disease. OBJECTIVES To investigate the accuracy of the Brief Cognitive Screening Battery (BCSB) in the differential diagnosis between AD, non-AD cognitive impairment (both defined by cerebrospinal fluid [CSF] biomarkers) and healthy cognition, and to correlate CSF biomarker results with cognitive performance. METHODS Overall, 117 individuals were evaluated: 45 patients with mild cognitive impairment (MCI) or mild dementia within the AD continuum defined by the AT(N) classification [A+T+/-(N)+/]; 27 non-AD patients with MCI or mild dementia [A-T+/-(N)+/-]; and 45 cognitively healthy individuals without CSF biomarker results. All participants underwent evaluation using the BCSB. RESULTS The total BCSB and delayed recall (DR) scores of the BCSB memory test showed high diagnostic accuracy, as indicated by areas under the ROC curve (AUC): 0.89 and 0.87, respectively, for discrimination between AD and non-AD versus cognitively healthy controls. Similarly, total BCSB and DR displayed high accuracy (AUC-ROC curves of 0.89 and 0.91, respectively) for differentiation between AD and controls. BCSB tests displayed low accuracy for differentiation between AD and non-AD. The CSF levels of biomarkers correlated significantly, though weakly, with DR. CONCLUSIONS Total BCSB and DR scores presented good accuracy for differentiation between patients with a biological AD diagnosis and cognitively healthy individuals, but low accuracy for differentiating AD from non-AD patients.
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Affiliation(s)
- Patrícia Regina Henrique Peles
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | - Larissa de Souza Salvador
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Belo Horizonte MG, Brazil
| | - Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | - Paulo Caramelli
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Belo Horizonte MG, Brazil
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14
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Jo S, Nam SJ, Park KW, Lee JH, Lee CS. An Autopsy-Proven Case of Lewy Body Disease Presenting with Severe Dysphagia. J Mov Disord 2021; 14:242-244. [PMID: 33706474 PMCID: PMC8490184 DOI: 10.14802/jmd.20039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/12/2020] [Accepted: 10/20/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sungyang Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Jeong Nam
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kye Won Park
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Sik Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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15
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Orlović I, Bartolović M, Marušić K, Vlahović D, Šiško Markoš I, Karlović D, Peitl V. THE ENIGMA OF LEWY BODY DEMENTIA: A CASE REPORT. Acta Clin Croat 2020; 59:771-776. [PMID: 34285451 PMCID: PMC8253061 DOI: 10.20471/acc.2020.59.04.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/12/2019] [Indexed: 11/24/2022] Open
Abstract
Lewy body dementia is a progressive neurodegenerative disease and is considered to be the second most common cause of dementia in the elderly. Because of the complexity of clinical presentation, it is often misdiagnosed and mistaken for other dementias, which may result in administering inappropriate therapy, and thus worsening of the patient condition. We reviewed a case of a 71-year-old patient whose clinical presentation gradually occurred with complex visual hallucinations, atypical extrapyramidal motor symptoms, fluctuating cognitive impairments with delirious episodes, and oscillating syncope. Depressive mood, impaired daily functioning and sensitivity to antipsychotics were also noted. Extensive diagnostic workup was performed with neuropsychological testing and use of single-photon emission computerized tomography. Considering the clinical presentation and diagnostic procedures performed, the diagnosis of Lewy body dementia was set and pharmacotherapy was revised. We discuss the importance of taking overall clinical presentation and diagnostic treatment in consideration and applying appropriate therapy to slow down the progression of the disease and exacerbation of the patient's psychological functions.
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Affiliation(s)
- Ivona Orlović
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Matija Bartolović
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Katarina Marušić
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Darko Vlahović
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Ines Šiško Markoš
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Dalibor Karlović
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Vjekoslav Peitl
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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16
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Mengel D, Janelidze S, Glynn RJ, Liu W, Hansson O, Walsh DM. Plasma
NT1
Tau is a Specific and Early Marker of Alzheimer's Disease. Ann Neurol 2020; 88:878-892. [DOI: 10.1002/ana.25885] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 12/26/2022]
Affiliation(s)
- David Mengel
- Laboratory for Neurodegenerative Research, Ann Romney Center for Neurologic Diseases Brigham and Women's Hospital and Harvard Medical School Boston MA USA
- Department of Neurodegenerative Diseases, Center for Neurology and Hertie Institute for Clinical Brain Research University of Tübingen Tübingen Germany
| | - Shorena Janelidze
- Clinical Memory Research Unit, Faculty of Medicine Lund University Lund Sweden
| | - Robert J. Glynn
- Division of Preventive Medicine Brigham & Women's Hospital Boston MA USA
| | - Wen Liu
- Laboratory for Neurodegenerative Research, Ann Romney Center for Neurologic Diseases Brigham and Women's Hospital and Harvard Medical School Boston MA USA
| | - Oskar Hansson
- Clinical Memory Research Unit, Faculty of Medicine Lund University Lund Sweden
- Memory Clinic Skåne University Hospital Malmö Sweden
| | - Dominic M. Walsh
- Laboratory for Neurodegenerative Research, Ann Romney Center for Neurologic Diseases Brigham and Women's Hospital and Harvard Medical School Boston MA USA
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17
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Babiloni C, Pascarelli MT, Lizio R, Noce G, Lopez S, Rizzo M, Ferri R, Soricelli A, Nobili F, Arnaldi D, Famà F, Orzi F, Buttinelli C, Giubilei F, Salvetti M, Cipollini V, Bonanni L, Franciotti R, Onofrj M, Stirpe P, Fuhr P, Gschwandtner U, Ransmayr G, Aarsland D, Parnetti L, Farotti L, Marizzoni M, D'Antonio F, De Lena C, Güntekin B, Hanoğlu L, Yener G, Emek-Savaş DD, Triggiani AI, Taylor JP, McKeith I, Stocchi F, Vacca L, Hampel H, Frisoni GB, De Pandis MF, Del Percio C. Abnormal cortical neural synchronization mechanisms in quiet wakefulness are related to motor deficits, cognitive symptoms, and visual hallucinations in Parkinson's disease patients: an electroencephalographic study. Neurobiol Aging 2020; 91:88-111. [DOI: 10.1016/j.neurobiolaging.2020.02.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 01/31/2020] [Accepted: 02/28/2020] [Indexed: 11/25/2022]
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18
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Pardini M, Nobili F, Arnaldi D, Morbelli S, Bauckneht M, Rissotto R, Serrati C, Serafini G, Lapucci C, Ghio L, Amore M, Massucco D, Sassos D, Bonzano L, Mancardi GL, Roccatagliata L. 123I-FP-CIT SPECT validation of nigro-putaminal MRI tractography in dementia with Lewy bodies. Eur Radiol Exp 2020; 4:27. [PMID: 32363488 PMCID: PMC7196565 DOI: 10.1186/s41747-020-00153-6] [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: 11/12/2019] [Accepted: 03/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background Assessment of nigrostriatal degeneration is a key element to discriminate between dementia with Lewy bodies (DLB) and Alzheimer disease (AD), and it is often evaluated using ioflupane (123I-FP-CIT) single-photon emission computed tomography (SPECT). Given the limited availability of 123I-FP-CIT SPECT, we evaluated if a mask-based approach to nigroputaminal magnetic resonance imaging (MRI) diffusion-weighted tractography could be able to capture microstructural changes reflecting nigroputaminal degeneration in DLB. Methods A nigroputaminal bundle mask was delineated on 12 healthy volunteers (HV) and applied to MRI diffusion-weighted data of 18 subjects with DLB, 21 subjects with AD and another group of 12 HV. The correlation between nigroputaminal fractional anisotropy (FA) values and 123I-FP-CIT SPECT findings was investigated. Shapiro-Wilk, ANOVA, ANCOVA, and parametric correlation statistics as well as receiver operating characteristic (ROC) analysis were used. Results DLB patients showed a higher nigroputaminal FA values compared with both AD and HV-controls groups (p = 0.001 for both comparisons), while no difference was observed between HV-controls and AD groups (p = 0.450); at ROC analysis, the area under the curve for the discriminating DLB and AD subjects was 0.820; FA values correlated with 123I-FP-CIT values (on the left, r = -0.670; on the right, r = -720). No significant differences were observed for the FA of the corticospinal tract across the three groups (p = 0.740). Conclusions In DLB, nigroputaminal degeneration could be reliably assessed on MRI diffusion scans using a mask of nigroputaminal bundle trajectory. Nigroputaminal FA in DLB patients correlated with 123I-FP-CIT values data may allow to differentiate these patients from AD patients and HV-controls.
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Affiliation(s)
- Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Flavio Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Silvia Morbelli
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Bauckneht
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Carlo Serrati
- Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Lucio Ghio
- Psychiatry Branch, Galliera Hospital, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | | | - Davide Sassos
- Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Laura Bonzano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Giovanni Luigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Luca Roccatagliata
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. .,Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy.
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19
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Coindreau V, Chesnel C, Babany F, Declemy A, Savard E, Charlanes A, Lebreton F, Amarenco G. [Urinary tract symptoms in Lewy body dementia: About 19 cases]. Prog Urol 2020; 30:267-272. [PMID: 32224094 DOI: 10.1016/j.purol.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Lewy Body Dementia (LBD) is a Parkinsonian disorder which often leads to Lower Urinary Tract Symptoms (LUTS), especially an Overactive Bladder (OAB). There have been few LBD related LUTS depictions in the literature, which is why we did this retrospective study. METHODS Retrospective single institution study. RESULTS Nineteen patients with confirmed LBD diagnosis were found, (63% of men, mean age 74 years old). The main symptom was OAB (100% of patients) with frequent stress urinary incontinence (94%) associated with detrusor overactivity (93%) with pressure elevation (79%). Voiding difficulties were found in 16% of medical interviews, and in 53% of urodynamics. In total, 92% of patients complained of constipation, with 44% suffering from fecal incontinence. DISCUSSION LBD is characterized by alpha-synuclein aggregates in the cerebral cortex, thus explaining associated cognitive impairment. The most commonly found LUTS is stress incontinence. We also found voiding difficulties in smaller proportion, sometimes associated with prostatism. Topographically, these symptoms could be explained by alpha-synuclein aggregates in the frontal and temporal cortex and the pons. Anorectal disorder and sexual dysfunction were frequently associated. Urological complications are scarce in this population, screening is focused in increasing quality of life, and the possibility to discriminate the different types of Parkinsonisms. CONCLUSION OAB is the most common lower urinary tract symptom in LBD often associated with detrusor overactivity, and less frequently voiding difficulties sometimes associated to prostatism. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- V Coindreau
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - C Chesnel
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Babany
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Declemy
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - E Savard
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Charlanes
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Lebreton
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - G Amarenco
- Groupe de recherche clinique en neuro-urologie (GREEN GRC-01 UPMC), Sorbonne universités, 75005 Paris, France; Service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
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20
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Piovezan RD, Oliveira D, Arias N, Acosta D, Prince MJ, Ferri CP. Mortality Rates and Mortality Risk Factors in Older Adults with Dementia from Low- and Middle-Income Countries: The 10/66 Dementia Research Group Population-Based Cohort Study. J Alzheimers Dis 2020; 75:581-593. [PMID: 32310178 PMCID: PMC7306886 DOI: 10.3233/jad-200078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Dementia is the main cause of disability in older people living in low- and middle-income countries (LMIC). Monitoring mortality rates and mortality risk factors in people with dementia (PwD) may contribute to improving care provision. OBJECTIVE We aimed to estimate mortality rates and mortality predictors in PwD from eight LMICs. METHODS This 3-5-year prospective cohort study involved a sample of 1,488 older people with dementia from eight LMIC. Total, age- and gender-specific mortality rates per 1,000 person-years at risk, as well as the total, age- and gender-adjusted mortality rates were estimated for each country's sub-sample. Cox's regressions were used to establish the predictors of mortality. RESULTS At follow-up, vital status of 1,304 individuals (87.6%) was established, of which 593 (45.5%) were deceased. Mortality rate was higher in China (65.9%) and lower in Mexico (26.9%). Mortality risk was higher in males (HR = 1.57; 95% CI: 1.32,1.87) and increased with age (HR = 1.04; 95% CI: 1.03,1.06). Neuropsychiatric symptoms (HR = 1.03; 95% CI: 1.01,1.05), cognitive decline (HR 1.04; 95% CI: 1.03,1.05), undernutrition (HR = 1.55; 95% CI: 1.19, 2.02), physical impairments (HR = 1.15; 95% CI: 1.03,1.29), and disease severity (HR = 1.43; 95% CI: 1.22,1.63) predicted higher mortality risk. CONCLUSION Several factors predicted higher mortality risk in PwD in LMICs. Males, those with higher age, higher severity of neuropsychiatric symptoms, higher number of physical impairments, higher disease severity, lower cognitive performance, and undernutrition had higher mortality risk. Addressing these indicators of long-term adverse outcomes may potentially contribute to improved advanced care planning, reducing the burden of disease in low-resourced settings.
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Affiliation(s)
- Ronaldo D. Piovezan
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychobiology, São Paulo, Brazil
| | - Déborah Oliveira
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychiatry, São Paulo, Brazil
| | - Nicole Arias
- Institute for Justice Research and Development, College of Social Work, Florida State University, Tallahassee, FL, USA
| | - Daisy Acosta
- Universidad Nacional Pedro Henriquez Urena (UNPHU), Santo Domingo, Dominican Republic
| | - Martin J. Prince
- King’s College London, Health Services and Population Research, London, United Kingdom
| | - Cleusa P. Ferri
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychobiology, São Paulo, Brazil
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychiatry, São Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, International Research Centre Health Technology Assessment Unit, Sao Paulo, Brazil
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21
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Mehraram R, Kaiser M, Cromarty R, Graziadio S, O'Brien JT, Killen A, Taylor JP, Peraza LR. Weighted network measures reveal differences between dementia types: An EEG study. Hum Brain Mapp 2019; 41:1573-1590. [PMID: 31816147 PMCID: PMC7267959 DOI: 10.1002/hbm.24896] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/03/2019] [Accepted: 11/29/2019] [Indexed: 11/18/2022] Open
Abstract
The diagnosis of dementia with Lewy bodies (DLB) versus Alzheimer's disease (AD) can be difficult especially early in the disease process. However, one inexpensive and non‐invasive biomarker which could help is electroencephalography (EEG). Previous studies have shown that the brain network architecture assessed by EEG is altered in AD patients compared with age‐matched healthy control people (HC). However, similar studies in Lewy body diseases, that is, DLB and Parkinson's disease dementia (PDD) are still lacking. In this work, we (a) compared brain network connectivity patterns across conditions, AD, DLB and PDD, in order to infer EEG network biomarkers that differentiate between these conditions, and (b) tested whether opting for weighted matrices led to more reliable results by better preserving the topology of the network. Our results indicate that dementia groups present with reduced connectivity in the EEG α band, whereas DLB shows weaker posterior–anterior patterns within the β‐band and greater network segregation within the θ‐band compared with AD. Weighted network measures were more consistent across global thresholding levels, and the network properties reflected reduction in connectivity strength in the dementia groups. In conclusion, β‐ and θ‐band network measures may be suitable as biomarkers for discriminating DLB from AD, whereas the α‐band network is similarly affected in DLB and PDD compared with HC. These variations may reflect the impairment of attentional networks in Parkinsonian diseases such as DLB and PDD.
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Affiliation(s)
- Ramtin Mehraram
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK.,Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruth Cromarty
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Sara Graziadio
- NIHR Newcastle in vitro Diagnostics Co-operative, Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK
| | - Alison Killen
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Luis R Peraza
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,IXICO Plc, London, UK
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22
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Galbiati A, Carli G, Hensley M, Ferini-Strambi L. REM Sleep Behavior Disorder and Alzheimer's Disease: Definitely No Relationship? J Alzheimers Dis 2019; 63:1-11. [PMID: 29578489 DOI: 10.3233/jad-171164] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a REM sleep parasomnia characterized by the loss of the typical muscular atonia present during healthy REM sleep. RBD can occur in the absence of other neurological conditions or in association with a neurodegenerative disorder. It is now well established that RBD is a strong predictor of neurodegeneration, in particular synucleinopathies, such as Parkinson's disease, Lewy body dementia (LBD), or multiple system atrophy. However, some longitudinal studies report that a minority of patients develop either overlapping form of dementia or Alzheimer disease's (AD). Although AD is reported as a possible development in patients with RBD, it is in a limited number of cases and there are concerns about the accuracy of the diagnostic criteria. Neuropsychological impairments identified in cross-sectional studies of RBD patients describe a profile similar to that observed in dementia related to synucleinopathies. However, only deficits in executive function predict the development of neurodegeneration. Longitudinal studies reported the development of AD in RBD patients in about 7% of cases with variability ranging from 3% and 11%. Since the majority of longitudinal investigations do not report AD as a possible development for RBD patients the proportion may be overestimated. The study of the relationship between RBD and AD may be confounded by two factors that lead to misdiagnosis: the use of clinical criteria alone and the overlap between the clinical features and neuropathology of AD and LBD. Future studies to investigate this association must use updated diagnostic criteria incorporating ancillary investigations.
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Affiliation(s)
- Andrea Galbiati
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Center, Milan, Italy.,"Vita-Salute" San Raffaele University, Faculty of Psychology, Milan, Italy
| | - Giulia Carli
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Center, Milan, Italy
| | - Michael Hensley
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, Australia
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Center, Milan, Italy.,"Vita-Salute" San Raffaele University, Faculty of Psychology, Milan, Italy
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23
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Hansson O, Santillo AF, Meeter LH, Nilsson K, Landqvist Waldö M, Nilsson C, Blennow K, van Swieten JC, Janelidze S. CSF placental growth factor - a novel candidate biomarker of frontotemporal dementia. Ann Clin Transl Neurol 2019; 6:863-872. [PMID: 31139684 PMCID: PMC6529985 DOI: 10.1002/acn3.763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/30/2019] [Accepted: 02/15/2019] [Indexed: 12/12/2022] Open
Abstract
Objective Diagnosis of frontotemporal dementia (FTD) is complicated by the overlap of clinical symptoms with other dementia disorders. Development of robust fluid biomarkers is critical to improve the diagnostic work‐up of FTD. Methods CSF concentrations of placental growth factor (PlGF) were measured in the discovery cohort including patients with FTD (n = 27), Alzheimer disease (AD) dementia (n = 75), DLB or PDD (n = 47), subcortical vascular dementia (VaD, n = 33), mild cognitive impairment that later converted to AD (MCI‐AD, n = 34), stable MCI (sMCI, n = 62), and 50 cognitively healthy controls from the Swedish BioFINDER study. For validation, CSF PlGF was measured in additional independent cohort of FTD patients (n = 22) and controls (n = 18) from the Netherlands. Results In the discovery cohort, MCI, MCI‐AD, AD dementia, DLB‐PDD, VaD, and FTD patients all showed increased CSF levels of PlGF compared with controls (sMCI P = 0.019; MCI‐AD P = 0.005; AD dementia, DLB‐PDD, VaD, and FTD all P < 0.001). PlGF levels were 1.8–2.1‐fold higher in FTD than in AD, DLB‐PDD and VaD (all P < 0.001). PlGF distinguished with high accuracy FTD from controls and sMCI performing better than tau/Aβ42 (AUC 0.954–0.996 versus 0.564–0.754, P < 0.001). A combination of PlGF, tau, and Aβ42 (tau/Aβ42/PlGF) was more accurate than tau/Aβ42 when differentiating FTD from a group of other dementias (AUC 0.972 vs. 0.932, P < 0.01). Increased CSF levels of PlGF in FTD compared with controls were corroborated in the validation cohort. Interpretation CSF PlGF is increased in FTD compared with other dementia disorders, MCI, and healthy controls and might be useful as a diagnostic biomarker of FTD.
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Affiliation(s)
- Oskar Hansson
- Clinical Memory Research Unit Department of Clinical Sciences Malmö Lund University Malmö Sweden.,Memory Clinic Skåne University Hospital Malmö Sweden
| | - Alexander F Santillo
- Clinical Memory Research Unit Department of Clinical Sciences Malmö Lund University Malmö Sweden.,Memory Clinic Skåne University Hospital Malmö Sweden
| | - Lieke H Meeter
- Department of Neurology Erasmus Medical Center Rotterdam The Netherlands
| | - Karin Nilsson
- Clinical Memory Research Unit Department of Clinical Sciences Malmö Lund University Malmö Sweden
| | - Maria Landqvist Waldö
- Clinical Memory Research Unit Department of Clinical Sciences Malmö Lund University Malmö Sweden.,Clinical Sciences Helsingborg Department of Clinical Sciences Lund University Lund Sweden
| | - Christer Nilsson
- Clinical Memory Research Unit Department of Clinical Sciences Malmö Lund University Malmö Sweden.,Department of Neurology Skåne University Hospital Lund Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry The Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden.,Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
| | - John C van Swieten
- Department of Neurology Erasmus Medical Center Rotterdam The Netherlands.,Department of Clinical Genetics VU University Medical Center Amsterdam The Netherlands
| | - Shorena Janelidze
- Clinical Memory Research Unit Department of Clinical Sciences Malmö Lund University Malmö Sweden
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24
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Babiloni C, Del Percio C, Lizio R, Noce G, Lopez S, Soricelli A, Ferri R, Pascarelli MT, Catania V, Nobili F, Arnaldi D, Famà F, Aarsland D, Orzi F, Buttinelli C, Giubilei F, Onofrj M, Stocchi F, Vacca L, Stirpe P, Fuhr P, Gschwandtner U, Ransmayr G, Garn H, Fraioli L, Pievani M, Frisoni GB, D'Antonio F, De Lena C, Güntekin B, Hanoğlu L, Başar E, Yener G, Emek-Savaş DD, Triggiani AI, Franciotti R, Taylor JP, De Pandis MF, Bonanni L. Abnormalities of Resting State Cortical EEG Rhythms in Subjects with Mild Cognitive Impairment Due to Alzheimer's and Lewy Body Diseases. J Alzheimers Dis 2019; 62:247-268. [PMID: 29439335 DOI: 10.3233/jad-170703] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study tested the hypothesis that cortical sources of resting state eyes-closed electroencephalographic (rsEEG) rhythms reveal different abnormalities in cortical neural synchronization in groups of patients with mild cognitive impairment due to Alzheimer's disease (ADMCI) and dementia with Lewy bodies (DLBMCI) as compared to cognitively normal elderly (Nold) subjects. Clinical and rsEEG data in 30 ADMCI, 23 DLBMCI, and 30 Nold subjects were available in an international archive. Age, gender, and education were carefully matched in the three groups. The Mini-Mental State Evaluation (MMSE) score was matched between the ADMCI and DLBMCI groups. Individual alpha frequency peak (IAF) was used to determine the delta, theta, alpha1, alpha2, and alpha3 frequency band ranges. Fixed beta1, beta2, and gamma bands were also considered. eLORETA estimated the rsEEG cortical sources. Receiver operating characteristic curve (ROCC) classified these sources across individuals. Compared to Nold, IAF showed marked slowing in DLBMCI and moderate in ADMCI. Furthermore, the posterior alpha 2 and alpha 3 source activities were more abnormal in the ADMCI than the DLBMCI group, while widespread delta source activities were more abnormal in the DLBMCI than the ADMCI group. The posterior delta and alpha sources correlated with the MMSE score and correctly classified the Nold and MCI individuals (area under the ROCC >0.85). In conclusion, the ADMCI and DLBMCI patients showed different features of cortical neural synchronization at delta and alpha frequencies underpinning brain arousal and vigilance in the quiet wakefulness. Future prospective cross-validation studies will have to test the clinical validity of these rsEEG markers.
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Affiliation(s)
- Claudio Babiloni
- Department of Physiology and Pharmacology "Vittorio Erspamer", University of Rome "La Sapienza", Rome, Italy.,Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome, Italy
| | | | - Roberta Lizio
- Department of Physiology and Pharmacology "Vittorio Erspamer", University of Rome "La Sapienza", Rome, Italy.,Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome, Italy
| | - Giuseppe Noce
- Department of Integrated Imaging, IRCCS SDN, Naples, Italy
| | - Susanna Lopez
- Department of Physiology and Pharmacology "Vittorio Erspamer", University of Rome "La Sapienza", Rome, Italy
| | - Andrea Soricelli
- Department of Integrated Imaging, IRCCS SDN, Naples, Italy.,Department of Motor Sciences and Healthiness, University of Naples Parthenope, Naples, Italy
| | - Raffaele Ferri
- Department of Neurology, IRCCS Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Enna, Italy
| | - Maria Teresa Pascarelli
- Department of Neurology, IRCCS Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Enna, Italy
| | - Valentina Catania
- Department of Neurology, IRCCS Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Enna, Italy
| | - Flavio Nobili
- Department of Neuroscience (DiNOGMI), Clinical Neurology, University of Genoa and IRCCS AOU S Martino-IST, Genoa, Italy
| | - Dario Arnaldi
- Department of Neuroscience (DiNOGMI), Clinical Neurology, University of Genoa and IRCCS AOU S Martino-IST, Genoa, Italy
| | - Francesco Famà
- Department of Neuroscience (DiNOGMI), Clinical Neurology, University of Genoa and IRCCS AOU S Martino-IST, Genoa, Italy
| | - Dag Aarsland
- Department of Old Age Psychiatry, King's College University, London, UK
| | - Francesco Orzi
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
| | - Carla Buttinelli
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
| | - Franco Giubilei
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
| | - Marco Onofrj
- Department of Neuroscience Imaging and Clinical Sciences and CESI, University G d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Fabrizio Stocchi
- Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome, Italy
| | - Laura Vacca
- Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome, Italy
| | - Paola Stirpe
- Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome, Italy
| | - Peter Fuhr
- Universitätsspital Basel, Abteilung Neurophysiologie, Basel, Switzerland
| | - Ute Gschwandtner
- Universitätsspital Basel, Abteilung Neurophysiologie, Basel, Switzerland
| | - Gerhard Ransmayr
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Medical Faculty of the Johannes Kepler University, Linz, Austria
| | - Heinrich Garn
- AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | | | - Michela Pievani
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giovanni B Frisoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Memory Clinic and LANVIE-Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Fabrizia D'Antonio
- Department of Neurology and Psychiatry, Sapienza, University of Rome, Italy
| | - Carlo De Lena
- Department of Neurology and Psychiatry, Sapienza, University of Rome, Italy
| | - Bahar Güntekin
- Department of Biophysics, Istanbul Medipol University, Istanbul, Turkey
| | - Lutfu Hanoğlu
- Department of Neurology, University of Istanbul-Medipol, Istanbul, Turkey
| | - Erol Başar
- IBG, Departments of Neurology and Neurosciences, Dokuz Eylül University, Izmir, Turkey
| | - Görsev Yener
- IBG, Departments of Neurology and Neurosciences, Dokuz Eylül University, Izmir, Turkey
| | - Derya Durusu Emek-Savaş
- Department of Psychology and Department of Neurosciences, Dokuz Eylül University, Izmir, Turkey
| | | | - Raffaella Franciotti
- Department of Neuroscience Imaging and Clinical Sciences and CESI, University G d'Annunzio of Chieti-Pescara, Chieti, Italy
| | | | | | - Laura Bonanni
- Department of Neuroscience Imaging and Clinical Sciences and CESI, University G d'Annunzio of Chieti-Pescara, Chieti, Italy
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25
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Babiloni C, Del Percio C, Lizio R, Noce G, Lopez S, Soricelli A, Ferri R, Pascarelli MT, Catania V, Nobili F, Arnaldi D, Famà F, Orzi F, Buttinelli C, Giubilei F, Bonanni L, Franciotti R, Onofrj M, Stirpe P, Fuhr P, Gschwandtner U, Ransmayr G, Fraioli L, Parnetti L, Farotti L, Pievani M, D'Antonio F, De Lena C, Güntekin B, Hanoğlu L, Yener G, Emek-Savaş DD, Triggiani AI, Taylor JP, McKeith I, Stocchi F, Vacca L, Frisoni GB, De Pandis MF. Levodopa may affect cortical excitability in Parkinson's disease patients with cognitive deficits as revealed by reduced activity of cortical sources of resting state electroencephalographic rhythms. Neurobiol Aging 2019; 73:9-20. [DOI: 10.1016/j.neurobiolaging.2018.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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26
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Foguem C, Manckoundia P. Lewy Body Disease: Clinical and Pathological “Overlap Syndrome” Between Synucleinopathies (Parkinson Disease) and Tauopathies (Alzheimer Disease). Curr Neurol Neurosci Rep 2018; 18:24. [DOI: 10.1007/s11910-018-0835-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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27
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Babiloni C, Del Percio C, Lizio R, Noce G, Cordone S, Lopez S, Soricelli A, Ferri R, Pascarelli MT, Nobili F, Arnaldi D, Famà F, Aarsland D, Orzi F, Buttinelli C, Giubilei F, Onofrj M, Stocchi F, Stirpe P, Fuhr P, Gschwandtner U, Ransmayr G, Caravias G, Garn H, Sorpresi F, Pievani M, D'Antonio F, De Lena C, Güntekin B, Hanoğlu L, Başar E, Yener G, Emek-Savaş DD, Triggiani AI, Franciotti R, Frisoni GB, Bonanni L, De Pandis MF. Abnormalities of Cortical Neural Synchronization Mechanisms in Subjects with Mild Cognitive Impairment due to Alzheimer's and Parkinson's Diseases: An EEG Study. J Alzheimers Dis 2018. [PMID: 28621693 DOI: 10.3233/jad-160883] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of this retrospective and exploratory study was that the cortical sources of resting state eyes-closed electroencephalographic (rsEEG) rhythms might reveal different abnormalities in cortical neural synchronization in groups of patients with mild cognitive impairment due to Alzheimer's disease (ADMCI) and Parkinson's disease (PDMCI) as compared to healthy subjects. Clinical and rsEEG data of 75 ADMCI, 75 PDMCI, and 75 cognitively normal elderly (Nold) subjects were available in an international archive. Age, gender, and education were carefully matched in the three groups. The Mini-Mental State Evaluation (MMSE) was matched between the ADMCI and PDMCI groups. Individual alpha frequency peak (IAF) was used to determine the delta, theta, alpha1, alpha2, and alpha3 frequency band ranges. Fixed beta1, beta2, and gamma bands were also considered. eLORETA estimated the rsEEG cortical sources. Receiver operating characteristic curve (ROC) classified these sources across individuals. Results showed that compared to the Nold group, the posterior alpha2 and alpha3 source activities were more abnormal in the ADMCI than the PDMCI group, while the parietal delta source activities were more abnormal in the PDMCI than the ADMCI group. The parietal delta and alpha sources correlated with MMSE score and correctly classified the Nold and diseased individuals (area under the ROC = 0.77-0.79). In conclusion, the PDMCI and ADMCI patients showed different features of cortical neural synchronization at delta and alpha frequencies underpinning brain arousal and vigilance in the quiet wakefulness. Future prospective cross-validation studies will have to test these rsEEG markers for clinical applications and drug discovery.
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Affiliation(s)
- Claudio Babiloni
- Department of Physiology and Pharmacology "Vittorio Erspamer", University of Rome "La Sapienza", Rome, Italy.,Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome, Italy
| | | | - Roberta Lizio
- Department of Physiology and Pharmacology "Vittorio Erspamer", University of Rome "La Sapienza", Rome, Italy.,Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome, Italy
| | - Giuseppe Noce
- Department of Integrated Imaging, IRCCS SDN, Naples, Italy
| | - Susanna Cordone
- Department of Physiology and Pharmacology "Vittorio Erspamer", University of Rome "La Sapienza", Rome, Italy
| | - Susanna Lopez
- Department of Physiology and Pharmacology "Vittorio Erspamer", University of Rome "La Sapienza", Rome, Italy
| | - Andrea Soricelli
- Department of Integrated Imaging, IRCCS SDN, Naples, Italy.,Department of Motor Sciences and Healthiness, University of Naples Parthenope, Naples, Italy
| | - Raffaele Ferri
- Department of Neurology, IRCCS Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Enna, Italy
| | - Maria Teresa Pascarelli
- Department of Neurology, IRCCS Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Enna, Italy
| | - Flavio Nobili
- Clinical Neurology, dept of Neuroscience (DiNOGMI), University of Genoa and IRCCS AOU S Martino-IST, Genoa, Italy
| | - Dario Arnaldi
- Clinical Neurology, dept of Neuroscience (DiNOGMI), University of Genoa and IRCCS AOU S Martino-IST, Genoa, Italy
| | - Francesco Famà
- Clinical Neurology, dept of Neuroscience (DiNOGMI), University of Genoa and IRCCS AOU S Martino-IST, Genoa, Italy
| | - Dag Aarsland
- Department of Old Age Psychiatry, King's College University, London, UK
| | - Francesco Orzi
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
| | - Carla Buttinelli
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
| | - Franco Giubilei
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
| | - Marco Onofrj
- Department of Neuroscience Imaging and Clinical Sciences and CESI, University G d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Fabrizio Stocchi
- Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome, Italy
| | - Paola Stirpe
- Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome, Italy
| | - Peter Fuhr
- Universitätsspital Basel, Abteilung Neurophysiologie, Basel, Switzerland
| | - Ute Gschwandtner
- Universitätsspital Basel, Abteilung Neurophysiologie, Basel, Switzerland
| | - Gerhard Ransmayr
- Department of Neurology and Psychiatry and Faculty of Medicine, Johannes Kepler University Linz, General Hospital of the City of Linz, Linz, Austria
| | - Georg Caravias
- Department of Neurology and Psychiatry and Faculty of Medicine, Johannes Kepler University Linz, General Hospital of the City of Linz, Linz, Austria
| | - Heinrich Garn
- AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | | | - Michela Pievani
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Fabrizia D'Antonio
- Department of Neurology and Psychiatry, Sapienza, University of Rome, Italy
| | - Carlo De Lena
- Department of Neurology and Psychiatry, Sapienza, University of Rome, Italy
| | - Bahar Güntekin
- Department of Biophysics, Istanbul Medipol University, Istanbul, Turkey
| | - Lutfu Hanoğlu
- Department of Neurology, University of Istanbul-Medipol, Istanbul, Turkey
| | - Erol Başar
- Department of Neurosciences and Department of Neurology, Dokuz Eylül University Medical School, Izmir, Turkey
| | - Görsev Yener
- Department of Psychology and Department of Neurosciences, Dokuz Eylül University, Izmir, Turkey
| | - Derya Durusu Emek-Savaş
- Department of Psychology and Department of Neurosciences, Dokuz Eylül University, Izmir, Turkey
| | | | - Raffaella Franciotti
- Department of Neuroscience Imaging and Clinical Sciences and CESI, University G d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Giovanni B Frisoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Memory Clinic and LANVIE - Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Laura Bonanni
- Department of Neuroscience Imaging and Clinical Sciences and CESI, University G d'Annunzio of Chieti-Pescara, Chieti, Italy
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Hohenfeld C, Werner CJ, Reetz K. Resting-state connectivity in neurodegenerative disorders: Is there potential for an imaging biomarker? Neuroimage Clin 2018; 18:849-870. [PMID: 29876270 PMCID: PMC5988031 DOI: 10.1016/j.nicl.2018.03.013] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/06/2018] [Accepted: 03/14/2018] [Indexed: 12/14/2022]
Abstract
Biomarkers in whichever modality are tremendously important in diagnosing of disease, tracking disease progression and clinical trials. This applies in particular for disorders with a long disease course including pre-symptomatic stages, in which only subtle signs of clinical progression can be observed. Magnetic resonance imaging (MRI) biomarkers hold particular promise due to their relative ease of use, cost-effectiveness and non-invasivity. Studies measuring resting-state functional MR connectivity have become increasingly common during recent years and are well established in neuroscience and related fields. Its increasing application does of course also include clinical settings and therein neurodegenerative diseases. In the present review, we critically summarise the state of the literature on resting-state functional connectivity as measured with functional MRI in neurodegenerative disorders. In addition to an overview of the results, we briefly outline the methods applied to the concept of resting-state functional connectivity. While there are many different neurodegenerative disorders cumulatively affecting a substantial number of patients, for most of them studies on resting-state fMRI are lacking. Plentiful amounts of papers are available for Alzheimer's disease (AD) and Parkinson's disease (PD), but only few works being available for the less common neurodegenerative diseases. This allows some conclusions on the potential of resting-state fMRI acting as a biomarker for the aforementioned two diseases, but only tentative statements for the others. For AD, the literature contains a relatively strong consensus regarding an impairment of the connectivity of the default mode network compared to healthy individuals. However, for AD there is no considerable documentation on how that alteration develops longitudinally with the progression of the disease. For PD, the available research points towards alterations of connectivity mainly in limbic and motor related regions and networks, but drawing conclusions for PD has to be done with caution due to a relative heterogeneity of the disease. For rare neurodegenerative diseases, no clear conclusions can be drawn due to the few published results. Nevertheless, summarising available data points towards characteristic connectivity alterations in Huntington's disease, frontotemporal dementia, dementia with Lewy bodies, multiple systems atrophy and the spinocerebellar ataxias. Overall at this point in time, the data on AD are most promising towards the eventual use of resting-state fMRI as an imaging biomarker, although there remain issues such as reproducibility of results and a lack of data demonstrating longitudinal changes. Improved methods providing more precise classifications as well as resting-state network changes that are sensitive to disease progression or therapeutic intervention are highly desirable, before routine clinical use could eventually become a reality.
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Affiliation(s)
- Christian Hohenfeld
- RWTH Aachen University, Department of Neurology, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Cornelius J Werner
- RWTH Aachen University, Department of Neurology, Aachen, Germany; RWTH Aachen University, Section Interdisciplinary Geriatrics, Aachen, Germany
| | - Kathrin Reetz
- RWTH Aachen University, Department of Neurology, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany.
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29
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St Louis EK, Boeve AR, Boeve BF. REM Sleep Behavior Disorder in Parkinson's Disease and Other Synucleinopathies. Mov Disord 2018; 32:645-658. [PMID: 28513079 DOI: 10.1002/mds.27018] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 12/15/2022] Open
Abstract
Rapid eye movement sleep behavior disorder is characterized by dream enactment and complex motor behaviors during rapid eye movement sleep and rapid eye movement sleep atonia loss (rapid eye movement sleep without atonia) during polysomnography. Rapid eye movement sleep behavior disorder may be idiopathic or symptomatic and in both settings is highly associated with synucleinopathy neurodegeneration, especially Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure. Rapid eye movement sleep behavior disorder frequently manifests years to decades prior to overt motor, cognitive, or autonomic impairments as the presenting manifestation of synucleinopathy, along with other subtler prodromal "soft" signs of hyposmia, constipation, and orthostatic hypotension. Between 35% and 91.9% of patients initially diagnosed with idiopathic rapid eye movement sleep behavior disorder at a sleep center later develop a defined neurodegenerative disease. Less is known about the long-term prognosis of community-dwelling younger patients, especially women, and rapid eye movement sleep behavior disorder associated with antidepressant medications. Patients with rapid eye movement sleep behavior disorder are frequently prone to sleep-related injuries and should be treated to prevent injury with either melatonin 3-12 mg or clonazepam 0.5-2.0 mg to limit injury potential. Further evidence-based studies about rapid eye movement sleep behavior disorder are greatly needed, both to enable accurate prognostic prediction of end synucleinopathy phenotypes for individual patients and to support the application of symptomatic and neuroprotective therapies. Rapid eye movement sleep behavior disorder as a prodromal synucleinopathy represents a defined time point at which neuroprotective therapies could potentially be applied for the prevention of Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Erik K St Louis
- Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Angelica R Boeve
- Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Bradley F Boeve
- Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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30
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Functional cortical source connectivity of resting state electroencephalographic alpha rhythms shows similar abnormalities in patients with mild cognitive impairment due to Alzheimer's and Parkinson's diseases. Clin Neurophysiol 2018; 129:766-782. [PMID: 29448151 DOI: 10.1016/j.clinph.2018.01.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/30/2017] [Accepted: 01/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study tested the hypothesis that markers of functional cortical source connectivity of resting state eyes-closed electroencephalographic (rsEEG) rhythms may be abnormal in subjects with mild cognitive impairment due to Alzheimer's (ADMCI) and Parkinson's (PDMCI) diseases compared to healthy elderly subjects (Nold). METHODS rsEEG data had been collected in ADMCI, PDMCI, and Nold subjects (N = 75 for any group). eLORETA freeware estimated functional lagged linear connectivity (LLC) from rsEEG cortical sources. Area under receiver operating characteristic (AUROC) curve indexed the accuracy in the classification of Nold and MCI individuals. RESULTS Posterior interhemispheric and widespread intrahemispheric alpha LLC solutions were abnormally lower in both MCI groups compared to the Nold group. At the individual level, AUROC curves of LLC solutions in posterior alpha sources exhibited moderate accuracies (0.70-0.72) in the discrimination of Nold vs. ADMCI-PDMCI individuals. No differences in the LLC solutions were found between the two MCI groups. CONCLUSIONS These findings unveil similar abnormalities in functional cortical connectivity estimated in widespread alpha sources in ADMCI and PDMCI. This was true at both group and individual levels. SIGNIFICANCE The similar abnormality of alpha source connectivity in ADMCI and PDMCI subjects might reflect common cholinergic impairment.
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31
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Margolesky J, C Luca C, Singer C. Rapid Eye Movement Sleep Behavior Disorder Manifesting as Sign Language in a Patient with Dementia with Lewy Bodies. Mov Disord Clin Pract 2017; 4:623-624. [DOI: 10.1002/mdc3.12486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/12/2017] [Accepted: 02/21/2017] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Corneliu C Luca
- University of Miami Miller School of Medicine; Miami Florida
| | - Carlos Singer
- University of Miami Miller School of Medicine; Miami Florida
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32
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Levin J, Kurz A, Arzberger T, Giese A, Höglinger GU. The Differential Diagnosis and Treatment of Atypical Parkinsonism. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 113:61-9. [PMID: 26900156 DOI: 10.3238/arztebl.2016.0061] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 11/20/2015] [Accepted: 11/20/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Aside from idiopathic Parkinson syndrome (Parkinson's disease), there are a number of other, so-called atypical parkinsonian syndromes: dementia with Lewy bodies (DLB), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). DLB is a common disease, with a prevalence of 0.4% (400 cases per 100 000 persons) in the elderly; MSA and PSP both have a prevalence of 5 to 10 per 100 000 persons, while the prevalence of CBD is about 1 per 100 000. METHODS This review is based on pertinent publications retrieved by a selective literature search. RESULTS The atypical parkinsonian syndromes are synucleinopathies and tauopathies, i.e., disorders characterized by the abnormal deposition of the proteins α-synuclein and tau. The site of deposition is correlated with the clinical features. In DLB, synuclein is mainly deposited in neocortical neurons, with some brain stem involvement as well. The main clinical features are dementia and, later on, parkinsonism. In MSA, synuclein is deposited in oligodendrocytes, mainly in the cerebellum but also in the brain stem; the main clinical feature is autonomic dysfunction combined with parkinsonism or cerebellar ataxia. Synucleinopathies often impair REM (rapid eye movement) sleep. PSP and CBD, on the other hand, are primary tauopathies. PSP usually causes predominantly supranuclear vertical gaze palsy and early postural instability with falls, less commonly parkinsonism (PSP-P) or frontotemporal dementia (PSP-FTD) as its most prominent feature. CBD typically manifests itself as markedly asymmetrical parkinsonism with apraxia or cortical sensory disturbance. At present, there is no accepted causal treatment for any of these disorders; the available symptomatic treatments are of limited efficacy and are supported only by low-level evidence. CONCLUSION Causal treatments for neurodegenerative diseases are now being developed and tested, and thus a molecular diagnosis is desirable. This will require the cooperation of primary care physicians with specialized centers.
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Affiliation(s)
- Johannes Levin
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München and Chair for Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Department of Neurology, Ludwig-Maximilians-Universität München, German Center for Neurodegenerative Diseases (DZNE), Munich, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Center for Neuropathology and Prion Research (ZNP), Ludwig-Maximilians-Universität München, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München
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33
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Janelidze S, Hertze J, Nägga K, Nilsson K, Nilsson C, Wennström M, van Westen D, Blennow K, Zetterberg H, Hansson O. Increased blood-brain barrier permeability is associated with dementia and diabetes but not amyloid pathology or APOE genotype. Neurobiol Aging 2016; 51:104-112. [PMID: 28061383 PMCID: PMC5754327 DOI: 10.1016/j.neurobiolaging.2016.11.017] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/07/2016] [Accepted: 11/25/2016] [Indexed: 01/09/2023]
Abstract
Blood-brain barrier (BBB) dysfunction might be an important component of many neurodegenerative disorders. In this study, we investigated its role in dementia using large clinical cohorts. The cerebrospinal fluid (CSF)/plasma albumin ratio (Qalb), an indicator of BBB (and blood-CSF barrier) permeability, was measured in a total of 1015 individuals. The ratio was increased in patients with Alzheimer's disease, dementia with Lewy bodies or Parkinson's disease dementia, subcortical vascular dementia, and frontotemporal dementia compared with controls. However, this measure was not changed during preclinical or prodromal Alzheimer's disease and was not associated with amyloid positron emission tomography or APOE genotype. The Qalb was increased in diabetes mellitus and correlated positively with CSF biomarkers of angiogenesis and endothelial dysfunction (vascular endothelial growth factor, intracellular adhesion molecule 1, and vascular cell adhesion molecule 1). In healthy elderly, high body mass index and waist-hip ratio predicted increased Qalb 20 years later. In summary, BBB permeability is increased in major dementia disorders but does not relate to amyloid pathology or APOE genotype. Instead, BBB impairment may be associated with diabetes and brain microvascular damage.
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Affiliation(s)
- Shorena Janelidze
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Joakim Hertze
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Karin Nilsson
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Christer Nilsson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Department of Neurology, Skåne University Hospital, Lund, Sweden
| | | | - Malin Wennström
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Wallenberg Laboratory, Malmö, Sweden
| | - Danielle van Westen
- Department of Clinical Sciences, Diagnostic radiology, Lund University, Lund, Sweden; Imaging and Function, Skåne University Health Care, Lund, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden.
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Uchihara T. An order in Lewy body disorders: Retrograde degeneration in hyperbranching axons as a fundamental structural template accounting for focal/multifocal Lewy body disease. Neuropathology 2016; 37:129-149. [DOI: 10.1111/neup.12348] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Toshiki Uchihara
- Laboratory of Structural Neuropathology; Tokyo Metropolitan Institute of Medical Science; 2-1-6 Kamikitazawa, Setagaya Tokyo Japan
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35
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Pannee J, Portelius E, Minthon L, Gobom J, Andreasson U, Zetterberg H, Hansson O, Blennow K. Reference measurement procedure for CSF amyloid beta (Aβ) 1-42 and the CSF Aβ 1-42 /Aβ 1-40 ratio - a cross-validation study against amyloid PET. J Neurochem 2016; 139:651-658. [PMID: 27579672 DOI: 10.1111/jnc.13838] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 01/14/2023]
Abstract
A clinical diagnosis of Alzheimer's disease is currently made on the basis of results from cognitive tests in combination with medical history and general clinical evaluation, but the peptide amyloid-beta (Aβ) in cerebrospinal fluid (CSF) is increasingly used as a biomarker for amyloid pathology in clinical trials and in recently proposed revised clinical criteria for Alzheimer's disease. Recent analytical developments have resulted in mass spectrometry (MS) reference measurement procedures for absolute quantification of Aβ1-42 in CSF. The CSF Aβ1-42 /Aβ1-40 ratio has been suggested to improve the detection of cerebral amyloid deposition, by compensating for inter-individual variations in total Aβ production. Our aim was to cross-validate the reference measurement procedure as well as the Aβ1-42 /Aβ1-40 and Aβ1-42 /Aβ1-38 ratios in CSF, measured by high-resolution MS, with the cortical level of Aβ fibrils as measured by amyloid (18 F-flutemetamol) positron emission tomography (PET). We included 100 non-demented patients with cognitive symptoms from the Swedish BioFINDER study, all of whom had undergone both lumbar puncture and 18 F-flutemetamol PET. Comparing CSF Aβ1-42 concentrations with 18 F-flutemetamol PET showed high concordance with an area under the receiver operating characteristic curve of 0.85 and a sensitivity and specificity of 82% and 81%, respectively. The ratio of Aβ1-42 /Aβ1-40 or Aβ1-42 /Aβ1-38 significantly improved concordance with an area under the receiver operating characteristic curve of 0.95 and a sensitivity and specificity of 96% and 91%, respectively. These results show that the CSF Aβ1-42 /Aβ1-40 and Aβ1-42 /Aβ1-38 ratios using the described MS method are strongly associated with cortical Aβ fibrils measured by 18 F-flutemetamol PET.
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Affiliation(s)
- Josef Pannee
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Erik Portelius
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Lennart Minthon
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Memory Clinic, Department of Neurology, Skåne University Hospital, Malmö, Sweden
| | - Johan Gobom
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Ulf Andreasson
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden.,UCL Institute of Neurology, London, UK
| | - Oskar Hansson
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Memory Clinic, Department of Neurology, Skåne University Hospital, Malmö, Sweden
| | - Kaj Blennow
- Department of Psychiatry & Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
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Misra S, Chopra K, Saikia UN, Sinha VR, Sehgal R, Modi M, Medhi B. Effect of mesenchymal stem cells and galantamine nanoparticles in rat model of Alzheimer's disease. Regen Med 2016; 11:629-46. [PMID: 27582416 DOI: 10.2217/rme-2016-0032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIM The present study investigated the efficacy of bone marrow-derived mesenchymal stem cells (BM-MSCs) in combination with galantamine hydrobromide-loaded solid lipid nanoparticles (GH-SLNs) in intracerebroventricular (ICV)-isoproterenol-induced rat model of Alzheimer's disease. MATERIALS & METHODS BM-MSCs were harvested by dissecting femur and tibia of 8-10-week-old Wistar rats. 1 × 10(6) cells were administered intravenously once in ICV-isoproterenol-induced rats followed by GH-SLNs (5 mg/kg) for 3 weeks. RESULTS & CONCLUSION ICV-isoproterenol resulted in significant memory deficit. The results demonstrated rapid regain of memory in isoproterenol-induced amnesic rats, following single intravenous administration of BM-MSCs and oral administration of GH-SLNs for 21 days. The combination of BM-MSCs and GH-SLNs produced a more pronounced protective effect, therefore, could be explored for the management of Alzheimer's disease.
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Affiliation(s)
- Shubham Misra
- Department of Pharmacology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Kanwaljit Chopra
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India
| | - Uma Nahar Saikia
- Department of Histopathology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Vivek Ranjan Sinha
- Pharmaceutics Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Manish Modi
- Department of Neurology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
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Metals in Alzheimer’s and Parkinson’s Disease: Relevance to Dementia with Lewy Bodies. J Mol Neurosci 2016; 60:279-288. [DOI: 10.1007/s12031-016-0809-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/28/2016] [Indexed: 12/13/2022]
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Relation between Resting State Front-Parietal EEG Coherence and Executive Function in Parkinson's Disease. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2845754. [PMID: 27433473 PMCID: PMC4940525 DOI: 10.1155/2016/2845754] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 04/11/2016] [Accepted: 06/05/2016] [Indexed: 11/18/2022]
Abstract
Objective. To assess the relation between executive dysfunction (ED) in Parkinson's disease (PD) and resting state functional connectivity evaluated using electroencephalography (EEG) coherence. Methods. Sixty-eight nondemented sporadic PD patients were assessed using the Behavioural Assessment of the Dysexecutive Syndrome (BADS) to evaluate executive function. EEG coherence in the left frontoparietal electrode pair (F3-P3) and the right frontoparietal electrode pair (F4-P4) was analyzed in the alpha and theta range. The BADS scores were compared across the coherence groups, and the multiple logistic regression analysis was performed to assess the contribution of confounders. Results. The standardized BADS score was significantly lower in the low F3-P3 coherence group in the alpha range (Mann-Whitney U test, p = 0.032), though there was no difference between F4-P4 coherence group in the alpha range, F3-P3, and F4-P4 coherence groups in the theta range and the standardized BADS score. The multiple logistic regression analysis revealed the significant relation between the F3-P3 coherence group in alpha range and age-controlled standardized BADS score (p = 0.039, 95% CI = 1.002-1.062). Conclusion. The decrease in resting state functional connectivity between the frontal and parietal cortices especially in the left side is related to ED in PD.
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Janelidze S, Hertze J, Zetterberg H, Landqvist Waldö M, Santillo A, Blennow K, Hansson O. Cerebrospinal fluid neurogranin and YKL-40 as biomarkers of Alzheimer's disease. Ann Clin Transl Neurol 2015; 3:12-20. [PMID: 26783546 PMCID: PMC4704480 DOI: 10.1002/acn3.266] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/09/2015] [Accepted: 10/19/2015] [Indexed: 12/18/2022] Open
Abstract
Objective Widespread implementation of cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD) in clinical settings requires improved accuracy for diagnosis of prodromal disease and for distinguishing AD from non‐AD dementias. Novel and promising CSF biomarkers include neurogranin, a marker of synaptic degeneration, and YKL‐40, a marker of neuroinflammation. Methods CSF neurogranin and YKL‐40 were measured in a cohort of 338 individuals including cognitively healthy controls and patients with stable mild cognitive impairment (sMCI), MCI who later developed AD (MCI‐AD), AD dementia, Parkinson's disease dementia (PDD), dementia with Lewy bodies (DLB), vascular dementia (VaD), and frontotemporal dementia (FTD). The diagnostic accuracy of neurogranin and YKL‐40 were compared with the core AD biomarkers, β‐amyloid (Aβ42 and Aβ40) and tau. Results Neurogranin levels were increased in AD and decreased in non‐AD dementia compared with healthy controls. As a result, AD patients showed considerably higher CSF levels of neurogranin than DLB/PDD, VaD and FTD patients. CSF YKL‐40 levels were increased in AD compared with DLB/PDD but not with VaD or FTD. Neither CSF neurogranin nor YKL‐40 levels differed significantly between sMCI patients and MCI‐AD patients. Both biomarkers correlated positively with CSF Aβ40 and tau. CSF neurogranin and YKL‐40 could separate AD dementia from non‐AD dementias (neurogranin, area under the curve [AUC] = 0.761; YKL‐40, AUC = 0.604; Aβ42/neurogranin, AUC = 0.849; Aβ42/YKL‐40, AUC = 0.785), but the diagnostic accuracy was not better compared to CSF Aβ and tau (Aβ42, AUC = 0.755; tau AUC = 0.858; Aβ42/tau, AUC = 0.895; Aβ42/Aβ40, AUC = 0.881). Similar results were obtained when separating sMCI from MCI‐AD cases. Interpretation CSF neurogranin and YKL‐40 do not improve the diagnostic accuracy of either prodromal AD or AD dementia when compared to the core CSF AD biomarkers. Nevertheless, the CSF level of neurogranin is selectively increased in AD dementia, whereas YKL‐40 is increased in both AD and FTD suggesting that synaptic degeneration and glial activation may be important in these neurodegenerative conditions.
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Affiliation(s)
- Shorena Janelidze
- Clinical Memory Research Unit Department of Clinical Sciences, Malmö Lund University Malmö Sweden
| | - Joakim Hertze
- Clinical Memory Research Unit Department of Clinical Sciences, Malmö Lund University Malmö Sweden; Memory Clinic Skåne University Hospital Malmö Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden; Department of Molecular Neuroscience UCL Institute of Neurology Queen Square London United Kingdom
| | - Maria Landqvist Waldö
- Memory Clinic Skåne University Hospital Malmö Sweden; Section of Geriatric Psychiatry Department of Clinical Sciences Lund University Lund Sweden
| | - Alexander Santillo
- Clinical Memory Research Unit Department of Clinical Sciences, Malmö Lund University Malmö Sweden; Memory Clinic Skåne University Hospital Malmö Sweden
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit Department of Clinical Sciences, Malmö Lund University Malmö Sweden; Memory Clinic Skåne University Hospital Malmö Sweden
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Belin J, Houéto JL, Constans T, Hommet C, de Toffol B, Mondon K. [Geriatric particularities of Parkinson's disease: Clinical and therapeutic aspects]. Rev Neurol (Paris) 2015; 171:841-52. [PMID: 26573332 DOI: 10.1016/j.neurol.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/03/2015] [Accepted: 08/13/2015] [Indexed: 11/24/2022]
Abstract
Parkinson's disease (PD) is a frequent and complex progressive neurological disorder that increases in incidence with age. Although historically PD has been characterized by the presence of progressive dopaminergic neuronal loss of the substantia nigra, the disease process also involves neurotransmitters other that dopamine and regions of the nervous system outside the basal ganglia. Its clinical presentation in elderly subjects differs from that in younger subjects, with more rapid progression, less frequent tremor, more pronounced axial signs, more frequent non-motor signs linked to concomitant degeneration of non-dopaminergic systems, and more frequent associated lesions. Despite the high prevalence of PD in elderly subjects, few therapeutic trials have been conducted in geriatric patients. Nevertheless, to improve functional disability while ensuring drug tolerance, the principles of optimized and multidisciplinary clinical management have to be known. The aim of this review is to provide an update on clinical and therapeutic features of PD specifically observed in elderly subjects.
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Affiliation(s)
- J Belin
- Service de neurologie et de neurophysiologie clinique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France.
| | - J L Houéto
- Service de neurologie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - T Constans
- Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France; Service de médecine interne gériatrique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - C Hommet
- Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France; Service de médecine interne gériatrique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Centre mémoire de ressources et de recherche (CMRR) de la région Centre, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - B de Toffol
- Service de neurologie et de neurophysiologie clinique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France
| | - K Mondon
- Université François-Rabelais, 37000 Tours, France; Inserm U930, 37044 Tours cedex 9, France; Service de médecine interne gériatrique, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Centre mémoire de ressources et de recherche (CMRR) de la région Centre, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
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Chang CC, Lin PH, Chang YT, Chen NC, Huang CW, Lui CC, Huang SH, Chang YH, Lee CC, Lai WA. The Impact of Admission Diagnosis on Recurrent or Frequent Hospitalizations in 3 Dementia Subtypes: A Hospital-Based Cohort in Taiwan with 4 Years Longitudinal Follow-Ups. Medicine (Baltimore) 2015; 94:e2091. [PMID: 26579820 PMCID: PMC4652829 DOI: 10.1097/md.0000000000002091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Increasing numbers of patients with different types of dementia have resulted in the increasing medical care loads. It is not known whether explanatory factors for recurrent or prolong hospitalization were driven by the subtypes of dementia. We analyzed 203 dementia patients aged >65-year-old with a clinical diagnosis of Alzheimer disease (AD), vascular dementia (VaD), or Parkinsonism-related dementia (PRD). With a 4-year follow-up period, logistic regression analyses were used to identify predictors of dementia diagnosis, cerebrovascular risk factors, chronic systemic diseases, and the etiology for admission for recurrent (>4 times/4 years) or prolonged hospitalization stay (>14 days per hospitalization). There were 48 AD, 96 VaD, and 59 PRD patients that completed the 4-year study. The average length of hospital stay was significant, the shortest in AD and the longest in PRD (P = 0.01), whereas the frequency of hospitalization was not different among 3 dementia subtypes. Although delirium is the most common etiology for admission in the patients, diabetes mellitus (Odds ratio, OR = 2.79, P = 0.02), pneumonia (OR = 11.21, P < 0.001), and fall-related hip fracture (OR = 4.762, P = 0.029) were significantly associated with prolong hospitalization. Patients with coronary artery disease (OR = 9.87, P = 0.02), pneumonia (OR = 84.48, P < 0.001), urinary tract infection (OR = 55.09, P < 0.001), and fall-related fracture (OR = 141.7, P < 0.001) predict recurrent hospitalization. Dementia subtypes did not influence directly on the hospitalization courses. The etiologies for admission carried higher clinical significance, compared with the coexisted systemic diseases.
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Affiliation(s)
- Chiung-Chih Chang
- From the Cognition and Aging Center, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (CCC, YTC, NCC, CWH); Department of Health and Beauty, Shu-Zen College of Medicine and Management, Kaohsiung, Taiwan (PHL); Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (CCL, CCL); Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (SHH, YHC); and Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan (WAL)
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Relationship between Postural Deformities and Frontal Function in Parkinson's Disease. PARKINSON'S DISEASE 2015; 2015:462143. [PMID: 26351615 PMCID: PMC4550756 DOI: 10.1155/2015/462143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 11/18/2022]
Abstract
Postural deformities and executive dysfunction (ED) are common symptoms of Parkinson's disease (PD); however, the relationship between postural deformities and ED in patients with PD remains unclear. This study assessed the relationship between postural deformities and ED in patients with PD. Sixty-five patients with sporadic PD were assessed for the severity of postural deformities and executive function. The severity of postural deformities was scored using the United Parkinson's Disease Rating Scale item 28 score: no postural deformity (0), mild postural deformities (1), or severe postural deformities (2-4). Executive function was assessed using the Behavioral Assessment of the Dysexecutive Syndrome (BADS) and an age-controlled standardized BADS score <70 was defined as ED. Age-controlled standardized BADS scores were compared across the three groups using the Kruskal-Wallis test. Relationship between ED and the severity of postural deformities was assessed using the Mann-Whitney U test. Age-controlled standardized BADS score significantly differed among the three groups (P = 0.005). ED was significantly related to the severity of postural deformities (P = 0.0005). The severity of postural deformities was associated with a lower age-controlled standardized BADS score and ED, and these findings suggest that postural deformities were associated with frontal dysfunction in patients with PD.
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Caine D, Tinelli RJ, Hyare H, De Vita E, Lowe J, Lukic A, Thompson A, Porter MC, Cipolotti L, Rudge P, Collinge J, Mead S. The cognitive profile of prion disease: a prospective clinical and imaging study. Ann Clin Transl Neurol 2015; 2:548-58. [PMID: 26000326 PMCID: PMC4435708 DOI: 10.1002/acn3.195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives Prion diseases are dementing illnesses with poorly defined neuropsychological features. This is probably because the most common form, sporadic Creutzfeldt-Jakob disease, is often rapidly progressive with pervasive cognitive decline making detailed neuropsychological investigation difficult. This study, which includes patients with inherited, acquired (iatrogenic and variant) and sporadic forms of the disease, is the only large-scale neuropsychological investigation of this patient group ever undertaken and aimed to define a neuropsychological profile of human prion diseases. Methods A tailored short cognitive examination of all of the patients (n = 81), with detailed neuropsychological testing in a subset with mild disease (n = 30) and correlation with demographic, clinical, genetic (PRNP mutation and polymorphic codon 129 genotype), and other variables (MRI brain signal change in cortex, basal ganglia or thalamus; quantitative research imaging, cerebrospinal fluid 14-3-3 protein). Results Comparison with healthy controls showed patients to be impaired on all tasks. Principal components analysis showed a major axis of fronto-parietal dysfunction that accounted for approximately half of the variance observed. This correlated strongly with volume reduction in frontal and parietal gray matter on MRI. Examination of individual patients' performances confirmed early impairment on this axis, suggesting characteristic cognitive features in mild disease: prominent executive impairment, parietal dysfunction, a largely expressive dysphasia, with reduced motor speed. Interpretation Taken together with typical neurological features, these results complete a profile that should improve differential diagnosis in a clinical setting. We propose a tailored neuropsychological battery for early recognition of clinical onset of symptoms with potential for use in clinical trials involving at-risk individuals.
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Affiliation(s)
- Diana Caine
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust London, United Kingdom ; Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Renata J Tinelli
- Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust London, United Kingdom
| | - Harpreet Hyare
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Enrico De Vita
- Academic Neuroradiological Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology London, United Kingdom ; Lysholm Department of Neuroradiology, NHNN, University College London Hospitals NHS Foundation Trust London, United Kingdom
| | - Jessica Lowe
- Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Ana Lukic
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Andrew Thompson
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Marie-Claire Porter
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Lisa Cipolotti
- Department of Neuropsychology, NHNN, University College London Hospitals NHS Foundation Trust London, United Kingdom
| | - Peter Rudge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - John Collinge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
| | - Simon Mead
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospitals NHS Foundation Trust London, United Kingdom ; MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology London, United Kingdom
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Abstract
BACKGROUND Dementia with Lewy body (DLB) is considered to be the second most common form of neurodegenerative disorders after Alzheimer's disease (AD), affecting as many as 100,000 people in the UK and up to 1.3 million in the USA. However, nearly half of patients with DLB remain undiagnosed thus depriving many of them from an early and adequate treatment of their distressing symptoms. Accurate and early diagnosis of DLB is important for both patients and their caregivers, since the neuropsychiatric symptoms require specific management. METHODS In the current study, we review the most recent developments in the field of molecular nuclear imaging to diagnose DLB. RESULTS The review addresses, the neurotransmitter based (dopaminergic, cholinergic, and glutamatergic) nuclear imaging techniques, role of the autonomic dysfunction and its visualization in DLB with myocardial sympathetic imaging and vesicular catecholamine uptake, as well as the use of amyloid polypeptides and glial markers as molecular imaging probes in the clinical diagnosis of DLB. CONCLUSIONS Most of the above nuclear imaging methods are restricted to highly specialized clinical centers, and thus not applicable to a large number of patients requiring dementia (e.g. DLB) diagnosis in routine clinical setting. Validating them against more readily accessible peripheral biomarkers, e.g. CSF and blood biomarkers linked to the DLB process, may facilitate their use in wider clinical settings.
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Halpern AR, Golden HL, Magdalinou N, Witoonpanich P, Warren JD. Musical tasks targeting preserved and impaired functions in two dementias. Ann N Y Acad Sci 2015; 1337:241-8. [PMID: 25773640 PMCID: PMC4401999 DOI: 10.1111/nyas.12616] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Studies of musical abilities in dementia have for the most part been rather general assessments of abilities, for instance, assessing retention of music learned premorbidly. Here, we studied patients with dementias with contrasting cognitive profiles to explore specific aspects of music cognition under challenge. Patients suffered from Alzheimer's disease (AD), in which a primary impairment is in forming new declarative memories, or Lewy body disease (PD/LBD), a type of parkinsonism in which executive impairments are prominent. In the AD patients, we examined musical imagery. Behavioral and neural evidence confirms involvement of perceptual networks in imagery, and these are relatively spared in early stages of the illness. Thus, we expected patients to have relatively intact imagery in a mental pitch comparison task. For the LBD patients, we tested whether executive dysfunction would extend to music. We probed inhibitory skills by asking for a speeded pitch or timbre judgment when the irrelevant dimension was held constant or also changed. Preliminary results show that AD patients score similarly to controls in the imagery tasks, but PD/LBD patients are impaired relative to controls in suppressing some irrelevant musical dimensions, particularly when the required judgment varies from trial to trial.
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Affiliation(s)
- Andrea R Halpern
- Psychology Department, Bucknell University, Lewisburg, Pennsylvania
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Mak E, Su L, Williams GB, Watson R, Firbank MJ, Blamire AM, O'Brien JT. Progressive cortical thinning and subcortical atrophy in dementia with Lewy bodies and Alzheimer's disease. Neurobiol Aging 2015; 36:1743-1750. [PMID: 25649023 DOI: 10.1016/j.neurobiolaging.2014.12.038] [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] [Received: 10/13/2014] [Revised: 12/16/2014] [Accepted: 12/30/2014] [Indexed: 12/25/2022]
Abstract
Patterns of progressive cortical thinning in dementia with Lewy bodies (DLB) remain poorly understood. We examined spatiotemporal patterns of cortical thinning and subcortical atrophy over 12 months in DLB (n = 13), compared with Alzheimer's disease (AD) (n = 23) and healthy control subjects (HC) (n = 33). Rates of temporal thinning in DLB were relatively preserved compared with AD. Volumetric analyses subcortical changes revealed that the AD group demonstrated significantly increased hippocampal atrophy (-5.8%) relative to the HC (-1.7%; p < 0.001) and DLB groups (-2.5%, p = 0.006). Significant lateral ventricular expansion was also observed in AD (8.9%) compared with HC (4.3%; p < 0.001) and DLB (4.7%; p = 0.008) at trend level. There was no significant difference in subcortical atrophy and ventricular expansion between DLB and HC. In the DLB group, increased rates of cortical thinning in the frontal and parietal regions were significantly correlated with decline in global cognition (Mini-Mental State Examination) and motor deterioration (Unified Parkinson's Disease Rating Scale 3), respectively. Overall, AD and DLB are characterized by different spatiotemporal patterns of cortical thinning over time. Our findings warrant further consideration of longitudinal cortical thinning as a potential imaging marker to differentiate DLB from AD.
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Affiliation(s)
- Elijah Mak
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Guy B Williams
- Department of Clinical Neurosciences, Wolfson Brain Imaging Centre, University of Cambridge, UK
| | - Rosie Watson
- Department of Aged Care, The Royal Melbourne Hospital, Melbourne, Australia; Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, UK
| | - Michael J Firbank
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, UK
| | - Andrew M Blamire
- Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
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Lowther ER, O'Brien JT, Firbank MJ, Blamire AM. Lewy body compared with Alzheimer dementia is associated with decreased functional connectivity in resting state networks. Psychiatry Res 2014; 223:192-201. [PMID: 25035300 DOI: 10.1016/j.pscychresns.2014.06.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 05/23/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
Abstract
Resting state functional magnetic resonance imaging (fMRI) was used to measure whole brain functional connectivity within specific networks hypothesised to be more affected in dementia with Lewy bodies (DLB) (a disease characterised by prominent attentional deficits, spontaneous motor features of parkinsonism and depression) than in Alzheimer׳s disease (AD) and controls. This study involved 68 subjects (15 DLB, 13 AD and 40 controls) who were scanned using resting state BOLD (blood-oxygen-level-dependent) fMRI on a 3T MRI scanner. Functional connectivity was measured using a model-free independent component analysis approach that consisted of temporally concatenating the resting state fMRI data of all study subjects and investigating group differences using a back-reconstruction procedure. Resting state functional connectivity was affected in the default mode, salience, executive and basal ganglia networks in DLB subjects compared with AD and controls. Functional connectivity was lower in DLB compared with AD and controls in these networks, except for the basal ganglia network, where connectivity was greater in DLB. No resting state networks showed less connectivity in AD compared with DLB or controls. Our results suggest that functional connectivity of resting state networks can identify differences between DLB and AD subjects that may help to explain why DLB subjects have more frequent attentional deficits, parkinsonian symptoms, and depression than those with AD.
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Affiliation(s)
- Eva R Lowther
- Institute for Ageing and Health and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - John T O'Brien
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Michael J Firbank
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew M Blamire
- Institute for Cellular Medicine and Newcastle Magnetic Resonance Centre, Newcastle University, Newcastle upon Tyne, United Kingdom.
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Teramoto H, Morita A, Ninomiya S, Shiota H, Kamei S. Relation between freezing of gait and frontal function in Parkinson's disease. Parkinsonism Relat Disord 2014; 20:1046-9. [PMID: 25042341 DOI: 10.1016/j.parkreldis.2014.06.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/19/2014] [Accepted: 06/30/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Freezing of gait (FOG) is a common symptom of Parkinson's disease (PD). Although the pathophysiological mechanism of FOG is unknown, previous studies have suggested that frontal dysfunction is associated with FOG. The Behavioral Assessment of the Dysexecutive Syndrome (BADS) battery, which is wide-ranging neurological battery composed of six subtests, evaluates frontal function and is more sensitive to executive dysfunction (ED) than other tools in PD patients. This is the first study to assess the relation between FOG in the 'on' state and frontal dysfunction evaluated using BADS. METHODS Subjects were 65 patients with PD. Multiple logistic regression analysis was used to compare the age-controlled standardized BADS score, age, disease duration, Hoehn and Yahr (HY) stage, levodopa-equivalent daily dose, and Mini-Mental State Examination (MMSE) score across patients with FOG (n = 43) and patients without FOG (n = 22). Score on each of the six BADS subtests were compared across patients with and without FOG using the Mann-Whitney U test. RESULTS Multiple logistic regression analysis revealed that FOG was related to lower age-controlled standardized BADS score (P = 0.022) and higher HY stage (P = 0.009) but not to disease duration, levodopa equivalent daily dose, or MMSE score. Among the six BADS subtests, score on the Zoo Map Test, which evaluates problem solving and planning, was lower in patients with FOG than in patients without FOG. CONCLUSION These results support a relation between on-state FOG and frontal dysfunction in PD patients.
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Affiliation(s)
- Hiroko Teramoto
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, 173-8610 Tokyo, Japan
| | - Akihiko Morita
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, 173-8610 Tokyo, Japan.
| | - Satoko Ninomiya
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, 173-8610 Tokyo, Japan
| | - Hiroshi Shiota
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, 173-8610 Tokyo, Japan
| | - Satoshi Kamei
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, 173-8610 Tokyo, Japan
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Vann Jones SA, O'Brien JT. The prevalence and incidence of dementia with Lewy bodies: a systematic review of population and clinical studies. Psychol Med 2014; 44:673-683. [PMID: 23521899 DOI: 10.1017/s0033291713000494] [Citation(s) in RCA: 304] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) is increasingly recognized as a common cause of dementia in older people. However, its true frequency remains unclear, with previous studies reporting a prevalence range from zero to 22.8% of all dementia cases. This review aimed to establish the population prevalence and incidence for DLB and to compare this to its prevalence in secondary care settings. METHOD A literature review of all relevant population and clinical studies was conducted using PubMed. Additional references from papers found during that process were added to this. RESULTS DLB accounted for 4.2% of all diagnosed dementias in the community. In secondary care this increased to 7.5%. The incidence of DLB was 3.8% of new dementia cases. There was a significant increase in DLB diagnoses when using the revised (2005) International Consensus Criteria (ICC) for DLB compared to the original (1996) criteria. CONCLUSIONS DLB currently accounts for around one in 25 dementia cases diagnosed in the community and one in 13 cases in secondary care. The significantly higher rates of DLB in secondary care may reflect enhanced diagnostic accuracy in specialist settings and/or the increased morbidity and carer burden of the DLB syndrome compared to other dementias. However, the true prevalence is likely to be much higher because DLB diagnoses are often missed, although there is evidence that new criteria aid case identification.
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Affiliation(s)
- S A Vann Jones
- Institute for Ageing and Health, Newcastle University, UK
| | - J T O'Brien
- Institute for Ageing and Health, Newcastle University, UK
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Nieves JC, Lindgren H, Cortés U. Agent-Based Reasoning in Medical Planning and Diagnosis Combining Multiple Strategies. INT J ARTIF INTELL T 2014. [DOI: 10.1142/s0218213014400041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Medical reasoning describes a form of qualitative inquiry that examines the cognitive (thought) processes involved in making medical decision. In this field the goal for diagnostic reasoning is assessing causes of observed conditions in order to make informed choices about treatment. In order to design a diagnostic reasoning method we merge ideas from a hypothetic-deductive method and the Domino model. In this setting, we introduce the so called Hypothetic-Deductive-Domino (HD-D) algorithm. In addition, a multi-agent approach is presented, which takes advantage of the HD-D algorithm for illuminating different standpoints in a diagnostic reasoning and assessment process, and for reaching a well-founded conclusion. This multi-agent approach is based on the so called Observer and Validating agents. The Observer agents are supported by a deductive inference process and the Validating agents are supported by an abductive inference process. The knowledge bases of these agents are captured by a class of possibilistic logic programs. Hence, these agents are able to deal with qualitative information. The approach is illustrated by a real scenario from diagnosing dementia diseases.
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Affiliation(s)
- Juan Carlos Nieves
- Department of Computing Science, Umeå University, SE-901 87, Umeå, Sweden
| | - Helena Lindgren
- Department of Computing Science, Umeå University, SE-901 87, Umeå, Sweden
| | - Ulises Cortés
- Universitat Politècnica de Catalunya, Knowledge Engineering and Machine Learning Group, c/Jordi Girona 1-3, E-08034, Barcelona, Spain
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