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Amrami A, Singh NA, Ali F, Pham NTT, Stephens YC, Josephs KA, Whitwell JL. Clinical Utility of Tectal Plate Measurements on Magnetic Resonance Imaging in Progressive Supranuclear Palsy. Mov Disord 2024; 39:1402-1407. [PMID: 38586905 PMCID: PMC11341258 DOI: 10.1002/mds.29806] [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: 10/25/2023] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Midbrain atrophy is a characteristic feature of progressive supranuclear palsy (PSP), observed in PSP-Richardson's syndrome (PSP-RS) and to a lesser extent PSP-parkinsonism (PSP-P). OBJECTIVE Our aim was to critically evaluate the utility of manual magnetic resonance imaging measurements of the midbrain tectal plate as a diagnostic biomarker in PSP. METHODS Length of the tectal plate and width of the superior and inferior colliculi were measured in 40 PSP (20 PSP-RS and 20 PSP-P) patients and compared with 20 Parkinson's disease and 20 healthy control subjects. RESULTS Tectal plate length was reduced in both PSP groups compared with Parkinson's disease and control subjects and was most abnormal in PSP-RS followed by PSP-P. Reduced tectal plate length was associated with worse PSP Rating Scale scores. CONCLUSIONS Simple manual measurements of tectal plate length show utility as a diagnostic biomarker in PSP, particularly for PSP-RS.
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Affiliation(s)
- Abigail Amrami
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester-55905, MN, USA
| | | | - Farwa Ali
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester-55905, MN, USA
| | - Nha Trang Thu Pham
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester-55905, MN, USA
| | | | - Keith A. Josephs
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester-55905, MN, USA
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2
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Yoshida M, Akagi A, Miyahara H, Riku Y, Ando T, Ikeda T, Yabata H, Moriyoshi H, Koizumi R, Iwasaki Y. Macroscopic diagnostic clue for parkinsonism. Neuropathology 2022; 42:394-419. [PMID: 35996308 DOI: 10.1111/neup.12853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 12/25/2022]
Abstract
The neuropathological background of parkinsonism includes various neurodegenerative disorders, including Lewy body disease (LBD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). The pathological diagnostic procedure begins by assessing the macroscopic findings to evaluate the degenerative lesions in brains with the naked eye. Usually, degenerative lesions show variable atrophy and brownish discoloration in accordance with disease-specific profiles. These macroscopic appearances support neuropathologists in identifying the relevant regions for microscopic examination. The neuropathological diagnosis of parkinsonism is based on regional distribution and fundamental proteinopathies in neurons and glia cells. LBD and MSA are synucleinopathies, and PSP and CBD are tauopathies. Among them, glial-predominant proteinopathy (MSA, PSP, and CBD) may play a significant role in volume reduction. Therefore, macroscopic inspection provides the appropriate direction for assessment. The disease duration, the severity of lesions, and mixed pathologies make the validation of macroscopic observations more complicated. In this review, we outline the macroscopic diagnostic clues in LBD, MSA, PSP, and CBD that could help with pathological refinement.
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Affiliation(s)
- Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Akio Akagi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Hiroaki Miyahara
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Yuichi Riku
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Ando
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshimasa Ikeda
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Yabata
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology, Shiga University of Medical Science, Ohtsu
| | - Hideyuki Moriyoshi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuichi Koizumi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan.,Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
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3
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Characterization and diagnostic potential of R2* in early-stage progressive supranuclear palsy variants. Parkinsonism Relat Disord 2022; 101:43-48. [DOI: 10.1016/j.parkreldis.2022.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/08/2022] [Accepted: 06/24/2022] [Indexed: 01/12/2023]
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4
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Magnetic Resonance Planimetry in the Differential Diagnosis between Parkinson’s Disease and Progressive Supranuclear Palsy. Brain Sci 2022; 12:brainsci12070949. [PMID: 35884755 PMCID: PMC9313181 DOI: 10.3390/brainsci12070949] [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: 06/19/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/10/2022] Open
Abstract
The clinical differential diagnosis between Parkinson’s disease (PD) and progressive supranuclear palsy (PSP) is often challenging. The description of milder PSP phenotypes strongly resembling PD, such as PSP-Parkinsonism, further increased the diagnostic challenge and the need for reliable neuroimaging biomarkers to enhance the diagnostic certainty. This review aims to summarize the contribution of a relatively simple and widely available imaging technique such as MR planimetry in the differential diagnosis between PD and PSP, focusing on the recent advancements in this field. The development of accurate MR planimetric biomarkers, together with the implementation of automated algorithms, led to robust and objective measures for the differential diagnosis of PSP and PD at the individual level. Evidence from longitudinal studies also suggests a role of MR planimetry in predicting the development of the PSP clinical signs, allowing to identify PSP patients before they meet diagnostic criteria when their clinical phenotype can be indistinguishable from PD. Finally, promising evidence exists on the possible association between MR planimetric measures and the underlying pathology, with important implications for trials with new disease-modifying target therapies.
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5
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Olfati N, Shoeibi A, Litvan I. Clinical Spectrum of Tauopathies. Front Neurol 2022; 13:944806. [PMID: 35911892 PMCID: PMC9329580 DOI: 10.3389/fneur.2022.944806] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/20/2022] [Indexed: 11/20/2022] Open
Abstract
Tauopathies are both clinical and pathological heterogeneous disorders characterized by neuronal and/or glial accumulation of misfolded tau protein. It is now well understood that every pathologic tauopathy may present with various clinical phenotypes based on the primary site of involvement and the spread and distribution of the pathology in the nervous system making clinicopathological correlation more and more challenging. The clinical spectrum of tauopathies includes syndromes with a strong association with an underlying primary tauopathy, including Richardson syndrome (RS), corticobasal syndrome (CBS), non-fluent agrammatic primary progressive aphasia (nfaPPA)/apraxia of speech, pure akinesia with gait freezing (PAGF), and behavioral variant frontotemporal dementia (bvFTD), or weak association with an underlying primary tauopathy, including Parkinsonian syndrome, late-onset cerebellar ataxia, primary lateral sclerosis, semantic variant PPA (svPPA), and amnestic syndrome. Here, we discuss clinical syndromes associated with various primary tauopathies and their distinguishing clinical features and new biomarkers becoming available to improve in vivo diagnosis. Although the typical phenotypic clinical presentations lead us to suspect specific underlying pathologies, it is still challenging to differentiate pathology accurately based on clinical findings due to large phenotypic overlaps. Larger pathology-confirmed studies to validate the use of different biomarkers and prospective longitudinal cohorts evaluating detailed clinical, biofluid, and imaging protocols in subjects presenting with heterogenous phenotypes reflecting a variety of suspected underlying pathologies are fundamental for a better understanding of the clinicopathological correlations.
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Affiliation(s)
- Nahid Olfati
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- UC San Diego Department of Neurosciences, Parkinson and Other Movement Disorder Center, San Diego, CA, United States
| | - Ali Shoeibi
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Irene Litvan
- UC San Diego Department of Neurosciences, Parkinson and Other Movement Disorder Center, San Diego, CA, United States
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Diagnostic Performance for Differential Diagnosis of Atypical Parkinsonian Syndromes from Parkinson’s Disease Using Quantitative Indices of 18F-FP-CIT PET/CT. Diagnostics (Basel) 2022; 12:diagnostics12061402. [PMID: 35741212 PMCID: PMC9221712 DOI: 10.3390/diagnostics12061402] [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: 05/16/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 01/27/2023] Open
Abstract
We are aimed to evaluate the diagnostic performances of quantitative indices obtained from dual-phase 18F-FP-CIT PET/CT for differential diagnosis of atypical parkinsonian syndromes (APS) from Parkinson’s disease (PD). We analyzed 172 subjects, including 105 non-Parkinsonism, 26 PD, 8 PSP, 1 CBD, 8 MSA-P, 9 MSA-C, and 15 DLB retrospectively. Two sequential PET/CT scans were acquired at 5 min and 3 h. We compared subregional binding potentials, putamen-to-caudate nucleus ratio of the binding potential, asymmetry index, and degree of washout. To differentiate APS, all BPs in both early and late phases (except late BPbrainstem) and all factors of the percent change except for putamen in APS significantly differed from PD. When a cut-off for early BPcerebellum was set as 0.79, the sensitivity, specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy for differentiating APS 73.2%, 91.7%, 93.8%, 66.7%, and 80.0%. The early BPcerebellum showed significantly greater SP and PPV than the late quantitative indices. Combined criteria regarding both early and late indices exhibited only greater NPV. The quantitative indices showed high diagnostic performances in differentiating APS from PD. Our findings provide the dual-phase 18F-FP-CIT PET/CT would be useful for differentiating APS from PD.
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7
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A Review of Diagnostic Imaging Approaches to Assessing Parkinson's Disease. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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8
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Song J, Kim J, Lee MJ, Ahn JH, Lee DY, Youn J, Chung MJ, Kim Z, Cho JW. Differential diagnosis between Parkinson's disease and atypical parkinsonism based on gait and postural instability: Artificial intelligence using an enhanced weight voting ensemble model. Parkinsonism Relat Disord 2022; 98:32-37. [PMID: 35447488 DOI: 10.1016/j.parkreldis.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Parkinsonian diseases and cerebellar ataxia among movement disorders, are representative diseases which present with distinct pathological gaits. We proposed a machine learning system that can differentiate Parkinson's disease (PD), cerebellar ataxia and progressive supranuclear palsy Richardson syndrome (PSP-RS) based on postural instability and gait analysis. METHODS We screened 1467 gait (GAITRite) and postural instability (Pedoscan) analyses performed in Samsung Medical Center from January 2019 to December 2020. PD, probable PSP-RS, and cerebellar ataxia (i.e., probable MSA-C, hereditary ataxia, and sporadic adult-onset ataxia) were included in the study. The gated recurrent units for GaitRite and the deep neural network for Pedoscan were applied. The enhanced weight voting ensemble (EWVE) method was applied to incorporate the two modalities. RESULTS We included 551 PD, 38 PSP-RS, 113 cerebellar ataxia and among them, 71 were MSA-C. Pedoscan-based and Gait-based model showed high sensitivity but low specificity in differentiating atypical parkinsonism from PD. The EWVE showed significantly improved specificity and reliable performance in differentiation between PD vs. ataxia patients (AUC 0.974 ± 0.036, sensitivity 0.829 ± 0.217, specificity 0.969 ± 0.038), PD vs. MSA-C (AUC 0.975 ± 0.020, sensitivity 0.823 ± 0.162, specificity 0.932 ± 0.030) and PD vs. PSP-RS (AUC 0.963 ± 0.028, sensitivity 0.555 ± 0.157, specificity 0.936 ± 0.031). CONCLUSION We proposed reliable Pedoscan-based, Gait-based and EWVE model in differentiating gait disorders by integrating information from gait and postural instability. This model can provide diagnosis guidelines to primary caregivers and assist in differential diagnosis of PD from atypical parkinsonism for neurologists.
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Affiliation(s)
- Joomee Song
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Junghyun Kim
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jong Hyeon Ahn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Dong Yeong Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Myung Jin Chung
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Zero Kim
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.
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9
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Quattrone A, Bianco MG, Antonini A, Vaillancourt DE, Seppi K, Ceravolo R, Strafella AP, Tedeschi G, Tessitore A, Cilia R, Morelli M, Nigro S, Vescio B, Arcuri PP, De Micco R, Cirillo M, Weis L, Fiorenzato E, Biundo R, Burciu RG, Krismer F, McFarland NR, Mueller C, Gizewski ER, Cosottini M, Del Prete E, Mazzucchi S, Quattrone A. Development and Validation of Automated
Magnetic Resonance
Parkinsonism Index 2.0 to Distinguish
Progressive Supranuclear Palsy‐Parkinsonism
From
Parkinson's Disease. Mov Disord 2022; 37:1272-1281. [PMID: 35403258 PMCID: PMC9321546 DOI: 10.1002/mds.28992] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/11/2022] Open
Abstract
Background Differentiating progressive supranuclear palsy‐parkinsonism (PSP‐P) from Parkinson's disease (PD) is clinically challenging. Objective This study aimed to develop an automated Magnetic Resonance Parkinsonism Index 2.0 (MRPI 2.0) algorithm to distinguish PSP‐P from PD and to validate its diagnostic performance in two large independent cohorts. Methods We enrolled 676 participants: a training cohort (n = 346; 43 PSP‐P, 194 PD, and 109 control subjects) from our center and an independent testing cohort (n = 330; 62 PSP‐P, 171 PD, and 97 control subjects) from an international research group. We developed a new in‐house algorithm for MRPI 2.0 calculation and assessed its performance in distinguishing PSP‐P from PD and control subjects in both cohorts using receiver operating characteristic curves. Results The automated MRPI 2.0 showed excellent performance in differentiating patients with PSP‐P from patients with PD and control subjects both in the training cohort (area under the receiver operating characteristic curve [AUC] = 0.93 [95% confidence interval, 0.89–0.98] and AUC = 0.97 [0.93–1.00], respectively) and in the international testing cohort (PSP‐P versus PD, AUC = 0.92 [0.87–0.97]; PSP‐P versus controls, AUC = 0.94 [0.90–0.98]), suggesting the generalizability of the results. The automated MRPI 2.0 also accurately distinguished between PSP‐P and PD in the early stage of the diseases (AUC = 0.91 [0.84–0.97]). A strong correlation (r = 0.91, P < 0.001) was found between automated and manual MRPI 2.0 values. Conclusions Our study provides an automated, validated, and generalizable magnetic resonance biomarker to distinguish PSP‐P from PD. The use of the automated MRPI 2.0 algorithm rather than manual measurements could be important to standardize measures in patients with PSP‐P across centers, with a positive impact on multicenter studies and clinical trials involving patients from different geographic regions. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Andrea Quattrone
- Institute of Neurology, University “Magna Graecia” Catanzaro Italy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology University College London London United Kingdom
| | - Maria G. Bianco
- Department of Medical and Surgical Sciences University “Magna Graecia” Catanzaro Italy
- Neuroscience Research Center University “Magna Graecia” Catanzaro Italy
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration CESNE, Department of Neuroscience University of Padua Padua Italy
| | - David E. Vaillancourt
- Department of Applied Physiology and Kinesiology University of Florida Gainesville Florida USA
- Department of Neurology and Biomedical Engineering University of Florida Gainesville Florida USA
| | - Klaus Seppi
- Department of Neurology Medical University Innsbruck Innsbruck Austria
- Neuroimaging Core Facility Medical University Innsbruck Innsbruck Austria
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, Center for NeuroDegenerative Diseases University of Pisa Pisa Italy
| | - Antonio P. Strafella
- Krembil Brain Institute, UHN & Research Imaging Center, Campbell Family Mental Health Research Institute, CAMH University of Toronto Toronto Ontario Canada
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Center SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Center SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Roberto Cilia
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta Parkinson and Movement Disorders Unit Milan Italy
| | - Maurizio Morelli
- Institute of Neurology, University “Magna Graecia” Catanzaro Italy
| | - Salvatore Nigro
- Institute of Nanotechnology (NANOTEC) National Research Council Lecce Italy
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico" Tricase Italy
| | - Basilio Vescio
- Institute of Molecular Bioimaging and Physiology National Research Council (IBFM‐CNR) Catanzaro Italy
| | | | - Rosa De Micco
- Department of Advanced Medical and Surgical Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Center SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Mario Cirillo
- Department of Advanced Medical and Surgical Sciences University of Campania “Luigi Vanvitelli” Naples Italy
- MRI Research Center SUN‐FISM University of Campania “Luigi Vanvitelli” Naples Italy
| | - Luca Weis
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration CESNE, Department of Neuroscience University of Padua Padua Italy
| | | | - Roberta Biundo
- Department of General Psychology University of Padua Padua Italy
| | - Roxana G. Burciu
- Department of Kinesiology and Applied Physiology University of Delaware Newark Delaware USA
| | - Florian Krismer
- Department of Neurology Medical University Innsbruck Innsbruck Austria
- Neuroimaging Core Facility Medical University Innsbruck Innsbruck Austria
| | - Nikolaus R. McFarland
- Department of Neurology and Biomedical Engineering University of Florida Gainesville Florida USA
| | - Christoph Mueller
- Department of Neurology Medical University Innsbruck Innsbruck Austria
| | - Elke R. Gizewski
- Neuroimaging Core Facility Medical University Innsbruck Innsbruck Austria
- Department of Neuroradiology Medical University Innsbruck Innsbruck Austria
| | - Mirco Cosottini
- Department of Translational Research and New Technologies University of Pisa Pisa Italy
| | - Eleonora Del Prete
- Department of Clinical and Experimental Medicine, Center for NeuroDegenerative Diseases University of Pisa Pisa Italy
| | - Sonia Mazzucchi
- Department of Clinical and Experimental Medicine, Center for NeuroDegenerative Diseases University of Pisa Pisa Italy
| | - Aldo Quattrone
- Neuroscience Research Center University “Magna Graecia” Catanzaro Italy
- Institute of Molecular Bioimaging and Physiology National Research Council (IBFM‐CNR) Catanzaro Italy
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10
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Poisson A, Thobois S. Allucinazioni e morbo di Parkinson. Neurologia 2022. [DOI: 10.1016/s1634-7072(21)45999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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11
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Parkinsonism and tremor syndromes. J Neurol Sci 2021; 433:120018. [PMID: 34686357 DOI: 10.1016/j.jns.2021.120018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/06/2021] [Accepted: 09/29/2021] [Indexed: 01/22/2023]
Abstract
Tremor, the most common movement disorder, may occur in isolation or may co-exist with a variety of other neurologic and movement disorders including parkinsonism, dystonia, and ataxia. When associated with Parkinson's disease, tremor may be present at rest or as an action tremor overlapping in phenomenology with essential tremor. Essential tremor may be associated not only with parkinsonism but other neurological disorders, suggesting the possibility of essential tremor subtypes. Besides Parkinson's disease, tremor can be an important feature of other parkinsonian disorders, such as atypical parkinsonism and drug-induced parkinsonism. In addition, tremor can be a prominent feature in patients with other movement disorders such as fragile X-associated tremor/ataxia syndrome, and Wilson's disease in which parkinsonian features may be present. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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12
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"Parkinson's disease" on the way to progressive supranuclear palsy: a review on PSP-parkinsonism. Neurol Sci 2021; 42:4927-4936. [PMID: 34532773 DOI: 10.1007/s10072-021-05601-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022]
Abstract
Progressive supranuclear palsy (PSP) is a progressive atypical parkinsonian syndrome characterised by postural instability, supranuclear ophthalmoplegia, dysarthria, dysphagia, executive dysfunction and other features. This clinical presentation represents the classic PSP-Richardson syndrome (PSP-RS). However, several other clinical subtypes have been recognised, including PSP-parkinsonism (PSP-P), probably the second most common PSP variant. Unlike PSP-RS, PSP-P often presents with an asymmetric onset, tremor and a moderate initial response to levodopa, especially during the first years of the disease, thus resembling Parkinson's disease (PD). It runs a more favourable course, but over time, PSP-P may evolve clinically into PSP-RS. Therefore, it may seem that PSP-P stands clinically between PD and PSP. There are several peculiarities that can distinguish PSP-P from these entities. As there is lack of systematic reviews on PSP-P in the literature, we decided to summarise all the necessary data about the epidemiology, clinical picture, neuroimaging, genetics and other aspects of this PSP variant in order to provide complete information for the reader.
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Nuvoli S, Tanda G, Stazza ML, Palumbo B, Frantellizzi V, De Vincentis G, Spanu A, Madeddu G. 123I-Ioflupane SPECT and 18F-FDG PET Combined Use in the Characterization of Movement and Cognitive Associated Disorders in Neurodegenerative Diseases. Curr Alzheimer Res 2021; 18:196-207. [PMID: 34102975 DOI: 10.2174/1567205018666210608112302] [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: 11/19/2020] [Revised: 03/21/2021] [Accepted: 04/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Both movement (MD) and cognitive (CD) disorders can occur associated in some neurodegenerative diseases, such as Parkinson's disease (PD) and Alzheimer's disease (AD). OBJECTIVE We further investigated the usefulness of 123I-Ioflupane SPECT and 18F-FDG PET combined use in patients with these disorders in the early stage. METHODS We retrospectively enrolled twenty-five consecutive patients with MD and CD clinical symptoms of recent appearance. All patients had undergone neurologic examination, neuropsychological tests, and magnetic resonance imaging. 123I-Ioflupane SPECT was performed in all cases, followed by 18F-FDG PET two weeks later. In the two procedures, both qualitative (QL) and quantitative (QN) image analyses were determined. RESULTS In patients with both 123I-Ioflupane SPECT and 18F-FDG PET pathologic data, associated dopaminergic and cognitive impairments were confirmed in 56% of cases. Pathologic SPECT with normal PET in 16% of cases could diagnose MD and exclude an associated CD, despite clinical symptoms. On the contrary, normal SPECT with pathologic PET in 28% of cases could exclude basal ganglia damage while confirming CD. QN 123I-Ioflupane SPECT analysis showed better performance than QL since QN correctly characterized two cases of MD with normal QL. Moreover, correct classification of normal metabolism was made only by QN analysis of 18F-FDG PET in four cases, despite suspect areas of hypometabolism at QL. CONCLUSION The combined use of these imaging procedures proved a reliable diagnostic tool to accurately identify and characterize MD and CD in early stage. QN analysis was effective in supporting QL evaluation, and its routine use is suggested, especially with inconclusive QL.
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Affiliation(s)
- Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giovanna Tanda
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Maria L Stazza
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Barbara Palumbo
- Section of Nuclear Medicine and Health Physics, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | | | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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14
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Fedorova NV, Bril EV, Kulua TK, Mikhaylova AD. [Progressive supranuclear palsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:111-119. [PMID: 34184486 DOI: 10.17116/jnevro2021121051111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Progressive supranuclear palsy (PSP) is a heterogeneous progressive neurodegenerative disease characterized by onset after 50 years old, Parkinson's syndrome, early development of postural instability, absence or transient reaction to levodopa drugs, neuropsychological disorders, dysphagia and dysarthria and eye movement disorders. The review provides an analysis of modern data on etiology, clinical presentation, differential diagnosis of the disease. The morphological picture and neuroimaging features, as well as modern ideas about treatment, are described. A great clinical polymorphism of the disease, as well as its similarity to other neurodegenerative diseases, manifested by Parkinson's syndrome, complicates the diagnosis of PSP. Establishing an accurate diagnosis makes it possible to determine the prognosis and further tactics of patient management.
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Affiliation(s)
- N V Fedorova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - E V Bril
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia.,Russian State Research Center - Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - T K Kulua
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - A D Mikhaylova
- Russian State Research Center - Burnasyan Federal Medical Biophysical Center, Moscow, Russia
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15
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Mood and emotional disorders associated with parkinsonism, Huntington disease, and other movement disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:175-196. [PMID: 34389117 DOI: 10.1016/b978-0-12-822290-4.00015-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This chapter provides a review of mood, emotional disorders, and emotion processing deficits associated with diseases that cause movement disorders, including Parkinson's disease, Lewy body dementia, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, frontotemporal dementia with parkinsonism, Huntington's disease, essential tremor, dystonia, and tardive dyskinesia. For each disorder, a clinical description of the common signs and symptoms, disease progression, and epidemiology is provided. Then the mood and emotional disorders associated with each of these diseases are described and discussed in terms of clinical presentation, incidence, prevalence, and alterations in quality of life. Alterations of emotion communication, such as affective speech prosody and facial emotional expression, associated with these disorders are also discussed. In addition, if applicable, deficits in gestural and lexical/verbal emotion are reviewed. Throughout the chapter, the relationships among mood and emotional disorders, alterations of emotional experiences, social communication, and quality of life, as well as treatment, are emphasized.
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Coughlin DG, Dickson DW, Josephs KA, Litvan I. Progressive Supranuclear Palsy and Corticobasal Degeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1281:151-176. [PMID: 33433875 DOI: 10.1007/978-3-030-51140-1_11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are neurodegenerative tauopathies with neuronal and glial lesions composed of tau that is composed predominantly of isomers with four repeats in the microtubule-binding domain (4R tau). The brain regions vulnerable to pathology in PSP and CBD overlap, but there are differences, particularly with respect to distribution of neuronal loss, the relative abundance of neuronal and glial lesions, the morphologic features of glial lesions, and the frequency of comorbid pathology. Both PSP and CBD have a wide spectrum of clinical manifestations, including disorders of movement and cognition. Recognition of phenotypic diversity in PSP and CBD may improve antemortem diagnostic accuracy, which tends to be very good for the most common presentation of PSP (Richardson syndrome), but poor for the most characteristic presentation of CBD (corticobasal syndrome: CBS). Development of molecular and imaging biomarkers may improve antemortem diagnostic accuracy. Currently, multidisciplinary symptomatic and supportive treatment with pharmacological and non-pharmacological strategies remains the standard of care. In the future, experimental therapeutic trials will be important to slow disease progression.
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Affiliation(s)
| | | | | | - Irene Litvan
- UC San Diego Department of Neurosciences, La Jolla, CA, USA.
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17
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Mangesius S, Mariotto S, Ferrari S, Pereverzyev S, Lerchner H, Haider L, Gizewski ER, Wenning G, Seppi K, Reindl M, Poewe W. Novel decision algorithm to discriminate parkinsonism with combined blood and imaging biomarkers. Parkinsonism Relat Disord 2020; 77:57-63. [DOI: 10.1016/j.parkreldis.2020.05.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 01/23/2023]
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18
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Coughlin DG, Litvan I. Progressive supranuclear palsy: Advances in diagnosis and management. Parkinsonism Relat Disord 2020; 73:105-116. [PMID: 32487421 PMCID: PMC7462164 DOI: 10.1016/j.parkreldis.2020.04.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 02/07/2023]
Abstract
Progressive supranuclear palsy (PSP) is a complex clinicopathologic disease with no current cure or disease modulating therapies that can only be definitively confirmed at autopsy. Growing understanding of the phenotypic diversity of PSP has led to expanded clinical criteria and new insights into etiopathogenesis that coupled with improved in vivo biomarkers makes increased access to current clinical trials possible. Current standard-of-care treatment of PSP is multidisciplinary, supportive and symptomatic, and several trials of potentially disease modulating agents have already been completed with disappointing results. Current ongoing clinical trials target the abnormal aggregation of tau through a variety of mechanisms including immunotherapy and gene therapy offer a more direct method of treatment. Here we review PSP clinicopathologic correlations, in vivo biomarkers including MRI, PET, and CSF biomarkers. We additionally review current pharmacologic and non-pharmacologic methods of treatment, prior and ongoing clinical trials in PSP. Newly expanded clinical criteria and improved specific biomarkers will aid in identifying patients with PSP earlier and more accurately and expand access to these potentially beneficial clinical trials.
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Affiliation(s)
- David G Coughlin
- Department of Neurosciences, University of California San Diego, San Diego, CA, 92093, USA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, San Diego, CA, 92093, USA.
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Alster P, Madetko N, Koziorowski D, Friedman A. Progressive Supranuclear Palsy-Parkinsonism Predominant (PSP-P)-A Clinical Challenge at the Boundaries of PSP and Parkinson's Disease (PD). Front Neurol 2020; 11:180. [PMID: 32218768 PMCID: PMC7078665 DOI: 10.3389/fneur.2020.00180] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/24/2020] [Indexed: 12/11/2022] Open
Abstract
Progressive Supranuclear Palsy (PSP) and Parkinson's Disease (PD), especially in their early stages, show overlapping clinical manifestations. The criteria for the diagnosis of PSP, released in 2017, indicate four basic features of the disease—postural instability (P), akinesia (A), oculomotor dysfunction (O) and cognitive and lingual disorders (C), which clarify the interpretation of the disease. There is growing interest in the second most common variant of PSP—parkinsonism predominant PSP-P. It is observed in up to 35% of cases. The diagnosis of PSP-P requires the presence of akinetic-rigid predominantly axial and levodopa resistant parkinsonism (A2) or parkinsonism with tremor and/or asymmetric and/or levodopa responsive (A3). The development of supplementary methods of examination added new insights to observations related to PSP-P. Among the methods recently analyzed are freezing of swallowing and speech breathing assessment, transcranial sonography, and various methods using magnetic resonance imaging, such as pons/midbrain area ratio and magnetic resonance parkinsonism index (MRPI), fractional anisotropy or mean diffusivity. The proper examination of overlapping parkinsonian syndromes, regardless of the development of the method of examination, remains an incompletely explored issue. The aim of this review is to elucidate which factors may be interpreted as influential in the differential diagnosis of PSP-P, PSP-RS and postural instability and gait difficulty (PIGD) subtype of Parkinson's disease (PD).
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Affiliation(s)
- Piotr Alster
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Natalia Madetko
- Department of Neurology, Wrocław Medical University, Wrocław, Poland
| | | | - Andrzej Friedman
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
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Abstract
PURPOSE OF REVIEW Being a disease with heterogeneous presentations and unclear consensus on its diagnostic criteria, it is difficult to differentiate vascular parkinsonism (VaP) from other neurodegenerative parkinsonism variants. Ongoing research on structural and functional neuroimaging targeting dopaminergic pathway provides us more insight into the pathophysiology of VaP to improve diagnostic accuracy. The aim of this article is to review how the emerging imaging modalities help the diagnostic process and treatment decision in VaP. RECENT FINDINGS Dopamine transporter imaging is a promising tool in differentiating presynaptic parkinsonism and VaP. It also predicts the levodopa responders in VaP. Advanced MRI techniques including volumetry, diffusion tensor imaging and sequences visualising substantia nigra are under development, and they are complementary to each other in detecting structural and functional changes in VaP, which is crucial to ensure the quality of future therapeutic trials for VaP. Dopamine transporter imaging is recommended to patients with suspected VaP. Multimodal MRI in VaP would be an important area to be investigated in the near future.
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Affiliation(s)
- Karen K Y Ma
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shi Lin
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- BrainNow Research Institute, Guangdong Province, Shenzhen, China
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- BrainNow Research Institute, Guangdong Province, Shenzhen, China.
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Shoeibi A, Olfati N, Litvan I. Frontrunner in Translation: Progressive Supranuclear Palsy. Front Neurol 2019; 10:1125. [PMID: 31695675 PMCID: PMC6817677 DOI: 10.3389/fneur.2019.01125] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/08/2019] [Indexed: 12/26/2022] Open
Abstract
Progressive supranuclear palsy (PSP) is a four-repeat tau proteinopathy. Abnormal tau deposition is not unique for PSP and is the basic pathologic finding in some other neurodegenerative disorders such as Alzheimer's disease (AD), age-related tauopathy, frontotemporal degeneration, corticobasal degeneration, and chronic traumatic encephalopathy. While AD research has mostly been focused on amyloid beta pathology until recently, PSP as a prototype of a primary tauopathy with high clinical-pathologic correlation and a rapid course is a crucial candidate for tau therapeutic research. Several novel approaches to slow disease progression are being developed. It is expected that the benefits of translational research in this disease will extend beyond the PSP population. This article reviews advances in the diagnosis, epidemiology, pathology, hypothesized etiopathogenesis, and biomarkers and disease-modifying therapeutic approaches of PSP that is leading it to become a frontrunner in translation.
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Affiliation(s)
- Ali Shoeibi
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nahid Olfati
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Irene Litvan
- UC San Diego Department of Neurosciences, Parkinson and Other Movement Disorder Center, La Jolla, CA, United States
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Shoeibi A, Litvan I, Juncos JL, Bordelon Y, Riley D, Standaert D, Reich SG, Shprecher D, Hall D, Marras C, Kluger B, Olfati N, Jankovic J. Are the International Parkinson disease and Movement Disorder Society progressive supranuclear palsy (IPMDS-PSP) diagnostic criteria accurate enough to differentiate common PSP phenotypes? Parkinsonism Relat Disord 2019; 69:34-39. [PMID: 31665686 DOI: 10.1016/j.parkreldis.2019.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/26/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
The International Parkinson Disease and Movement Disorder Society PSP study group (IPMDS-PSP) recently published new clinical diagnostic criteria for progressive supranuclear palsy (PSP). Currently, there is no data regarding the accuracy of these sets of criteria for differentiating various PSP phenotypes. We discuss the accuracy of the IPMDS-PSP criteria for differentiation of patients with the PSP- Richardson phenotype (PSP-RS) from those with the PSP-Parkinsonism (PSP-P) using data from a sample of 274 clinically diagnosed PSP patients participating in the Environmental Genetic PSP (ENGENE-PSP) case control study. Using National Institute of Neurological Disorders and Stroke and the Society for PSP (NINDS-SPSP) criteria and the Williams criteria we categorized 259 of these patients as probable PSP-RS and 15 as PSP-P. The IPD-MDS PSP-RS and PSP-P criteria were unable to distinguish the PSP-RS from the PSP-P phenotypes in this sample. Nearly all (92.6%; 240 out of 259) the PSP-RS patients and over half (60%; 9 out of 15) of the PSP-P patients fulfilled both the IPMDS criteria for PSP-RS and PSP-P. Applying the newly proposed multiple allocation extinction rules decreased the number of overlapping diagnoses among the NINDS-SPSP PSP-RS patients, however problems remained in the PSP-P group. Diagnostic accuracy might be improved by modification of timelines for development of falls and other parkinsonian features.
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Affiliation(s)
- Ali Shoeibi
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Irene Litvan
- Parkinson and Other Movement Disorder Center, UC San Diego Department of Neurosciences, La Jolla, CA, 92037, USA.
| | - Jorge L Juncos
- Department of Neurology, Emory University, School of Medicine, Atlanta, GA, USA
| | - Yvette Bordelon
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - David Riley
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - David Standaert
- Center for Neurodegeneration and Experimental Therapeutics, Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Stephen G Reich
- Department of Neurology, University of Maryland, Baltimore, MD, USA
| | - David Shprecher
- Department of Neurology, University of Utah, Salt City, Utah, USA; Cleo Roberts Clinic, Banner Sun Health Research Institute, Sun City, AZ, USA; Department of Neurology, University of Arizona, Phoenix, AZ, USA
| | - Deborah Hall
- Department of Neurology, Rush University Medical Center, Chicago, IL, USA
| | - Connie Marras
- Morto and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Research, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Benzi Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nahid Olfati
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Takamatsu Y, Matsuda N, Aiba I. The combination of short-step and wide-based gait is a gait characteristic in progressive supranuclear palsy: a retrospective, cross-sectional study. Eur Geriatr Med 2019; 10:809-815. [PMID: 34652693 DOI: 10.1007/s41999-019-00211-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/29/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Like Parkinson's disease (PD), gait disturbance is a major problem in progressive supranuclear palsy (PSP). Despite limited studies investigating the gait characteristics, we hypothesize that they differ from PD owing to the involvement of different brain lesions. Hence, this study aims to investigate the gait characteristics in patients with PSP by comparing with healthy older adults and patients with PD. METHODS We identified 27 PSP patients, 25 PD patients, and 25 neurologically healthy older persons. Using a device that detected the distribution of foot pressure during walking, we analyzed gait variables and measured the walking speed (cm/s), cadence (steps/min), step length (cm), step width (cm), foot angle (°), and gait cycle time (s). Additionally, we calculated the coefficient of variation (CV, %) on walking speed and cadence and analyzed the gait characteristics by the PSP subtypes. RESULTS In PSP and PD, the walking speed was slower and the step length was shorter than healthy controls. The CV of cadence in PSP was higher than healthy controls and PD. In PSP, the step width and foot angle were higher than healthy controls and PD. The gait cycle time was longer in PSP and PD than healthy controls. PSP with progressive freezing gait tended to display a faster walking speed. Furthermore, PSP with parkinsonism-resembling idiopathic PD tended to exhibit the larger step width and foot angle compared with PSP-Richardson's syndrome. CONCLUSION This study suggests that the gait of PSP was unstable with parkinsonism and wide-based, which might be similar to combining features of PD and cerebellar disorders.
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Affiliation(s)
- Yasuyuki Takamatsu
- Department of Rehabilitation, National Hospital Organization, Higashinagoya National Hospital, 5-101 Umemorizaka, Meito-ku, Nagoya, Aichi, 465-8620, Japan.
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan.
| | - Naomi Matsuda
- Department of Rehabilitation, National Hospital Organization, Higashinagoya National Hospital, 5-101 Umemorizaka, Meito-ku, Nagoya, Aichi, 465-8620, Japan
| | - Ikuko Aiba
- Department of Neurology, National Hospital Organization, Higashinagoya National Hospital, 5-101 Umemorizaka, Meito-ku, Nagoya, Aichi, 465-8620, Japan
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Kon T, Tomiyama M, Wakabayashi K. Neuropathology of Lewy body disease: Clinicopathological crosstalk between typical and atypical cases. Neuropathology 2019; 40:30-39. [PMID: 31498507 DOI: 10.1111/neup.12597] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/21/2022]
Abstract
Lewy body disease (LBD) is characterized by the presence of Lewy bodies (LBs) and Lewy neurites and comprises a diagnostic spectrum that includes Parkinson's disease (PD), PD with dementia, and dementia with LBs. LBs and Lewy neurites are insoluble aggregates composed mainly of phosphorylated α-synuclein and can be widely distributed throughout the central and peripheral nervous systems. The distribution of LBs may determine the LBD phenotype. Braak hypothesized that Lewy pathology progresses ascendingly from the peripheral nervous system to the olfactory bulbs and brainstem and then to other brain regions. Braak's PD staging suggests that LBD is a prion-like disease. Most typical PD cases fit with Braak's PD staging, but the scheme fails in some cases. Alzheimer's disease, progressive supranuclear palsy, corticobasal syndrome, multiple system atrophy, frontotemporal lobar degeneration, Creutzfeldt-Jakob disease, cerebrovascular diseases, and essential tremor are common misdiagnoses for pathologically confirmed LBD. LBD exhibits considerable heterogeneity in both clinical and pathological settings, which makes clinical diagnosis challenging.
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Affiliation(s)
- Tomoya Kon
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Neurology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masahiko Tomiyama
- Department of Neurology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Koichi Wakabayashi
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Fernández-Ferreira R, García-Santos RA, Rodríguez-Violante M, López-Martínez C, Becerra-Laparra IK, Torres-Pérez ME. Progressive supranuclear palsy as differential diagnosis of Parkinson's disease in the elderly. Rev Esp Geriatr Gerontol 2019; 54:251-256. [PMID: 31324404 DOI: 10.1016/j.regg.2019.04.002] [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: 11/05/2018] [Revised: 01/28/2019] [Accepted: 04/24/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Progressive supranuclear palsy (PSP) is a syndrome characterized by progressive parkinsonism with early falls due to postural instability, typically vertical gaze supranuclear ophthalmoplegia, pseudobulbar dysfunction, neck dystonia and upper trunk rigidity as well as mild cognitive dysfunction. Progressive supranuclear palsy must be differentiated from Parkinson's disease taking into account several so-called red flags. MATERIALS AND METHODS We report a case series hallmarked by gait abnormalities, falls and bradykinesia in which Parkinson's disease was the initial diagnosis. RESULTS Due to a torpid clinical course, magnetic resonance imaging (MRI) was performed demonstrating midbrain atrophy, highly suggestive of progressive supranuclear palsy. CONCLUSION The neuroradiological exams (magnetic resonance imaging, single photon emission computer tomography, and positron emission tomography) can be useful for diagnosis of PSP. Treatment with levodopa should be considered, especially in patients with a more parkinsonian phenotype.
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Affiliation(s)
| | - Raúl Anwar García-Santos
- Neurology Department, National Institute of Neurology and Neurosurgery, PC 14269, Mexico City, Mexico
| | - Mayela Rodríguez-Violante
- Clinical Laboratory of Neurodegenerative Diseases, National Institute of Neurology and Neurosurgery, PC 14269, Mexico City, Mexico
| | - Coral López-Martínez
- Geriatrics Department, Médica Sur Clinic & Foundation, PC 14050, Mexico City, Mexico
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26
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Zhang K, Liang Z, Wang C, Zhang X, Yu B, Liu X. Diagnostic validity of magnetic resonance parkinsonism index in differentiating patients with progressive supranuclear palsy from patients with Parkinson's disease. Parkinsonism Relat Disord 2019; 66:176-181. [PMID: 31420309 DOI: 10.1016/j.parkreldis.2019.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/30/2019] [Accepted: 08/09/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Progressive supranuclear palsy is a neuropathologically defined disease, and many studies worked on detecting the diagnostic use of Magnetic resonance imaging. This article purposed to detect the diagnostic performance of Magnetic resonance parkinsonism index (MRPI). METHODS We systematically searched electronic database PubMed for articles published since 1996 using the National Institute of Neurological Disorders and Stroke and Society for PSP (NINDS-SPSP) criteria as the diagnostic standard. Methodological quality was assessed by Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and software Review Manager 5.3, software STATA 14.0 and meta-disc were applied in statistics analysis. RESULTS Totally 14 articles were included in this article. MRPI is proved to have pooled sensitivity of 0.98, pooled specificity of 0.99 in differentiating patients with Progressive supranuclear palsy (PSP) from patients with Parkinson's disease (PD) and the area under the Receiver operating characteristic curve value was 1.00. CONCLUSION MRPI shows excellent performance in differentiating patients with PSP from patients with PD, the clinical usage of MRPI in auxiliary diagnosis of PSP is recommended.
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Affiliation(s)
- Kejia Zhang
- School of Clinical Medicine, Jilin University, Changchun, China
| | - Zhenzhen Liang
- NHC Key Lab of Radiobiology (Jilin University), Changchun, Jilin, 130021, China
| | - Chunpeng Wang
- School of Mathematics and Statistics, Northeast Normal University, Changchun, Jilin, 130000, China
| | - Xueyuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Binbin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Xin Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China.
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Marsili L, Bologna M, Kojovic M, Berardelli A, Espay AJ, Colosimo C. Dystonia in atypical parkinsonian disorders. Parkinsonism Relat Disord 2019; 66:25-33. [PMID: 31443953 DOI: 10.1016/j.parkreldis.2019.07.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023]
Abstract
Dystonia is common in the classic atypical parkinsonian disorders such as multiple system atrophy, progressive supranuclear palsy and corticobasal degeneration, and to a lesser extent in dementia with Lewy bodies. Its clinical phenomenology, including body distribution, timing of appearance, severity, and relationship to dopaminergic and other medications may vary considerably within and between atypical parkinsonian disorders. From a pathophysiological standpoint, the coexistence of dystonia with parkinsonism challenges the functional model of the basal ganglia. Clinical recognition of specific dystonic features may assist in the differential diagnosis of atypical parkinsonian disorders and in distinguishing them from Parkinson's disease. The presence of dystonia in atypical parkinsonian disorders informs management decisions. Reduction or withdrawal of levodopa should be considered if there is a close relationship between the onset of dystonia with periods of high dopaminergic tone. Botulinum neurotoxin may be considered in focal presentations. We here provide an updated overview of dystonia arising in the setting of atypical parkinsonian disorders, summarizing relevant clinical and clinicopathological studies, underlying pathophysiological mechanisms, diagnostic clues and potential pitfalls in the diagnosis. Finally, we suggest a tailored therapeutic approach for the management of these patients.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Maja Kojovic
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy.
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Phokaewvarangkul O, Bhidayasiri R. How to spot ocular abnormalities in progressive supranuclear palsy? A practical review. Transl Neurodegener 2019; 8:20. [PMID: 31333840 PMCID: PMC6617936 DOI: 10.1186/s40035-019-0160-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/25/2019] [Indexed: 12/11/2022] Open
Abstract
Background For parkinsonian disorders, progressive supranuclear palsy (PSP) continues to be significant for differential diagnosis. PSP presents a range of ocular abnormalities that have been suggested as optional tools for its early detection, apart from the principal characteristic of postural unsteadiness. Nonetheless, such symptoms may be difficult to identify, particularly during the early onset stage of the disorder. It may also be problematic to recognize these symptoms for general practitioners who lack the required experience or physicians who are not specifically educated and proficient in ophthalmology or neurology. Main body Thus, here, a methodical evaluation was carried out to identify seven oculomotor abnormalities occurring in PSP, comprising square wave jerks, the speed and range of saccades (slow saccades and vertical supranuclear gaze palsy), ‘round the houses’ sign, decreased blink rate, blepharospasm, and apraxia of eyelid opening. Inspections were conducted using direct visual observation. An approach to distinguish these signs during a bedside examination was also established. When presenting in a patient with parkinsonism or dementia, the existence of such ocular abnormalities could increase the risk of PSP. For the distinction between PSP and other parkinsonian disorders, these signs hold significant value for physicians. Conclusion The authors urge all concerned physicians to check for such abnormalities with the naked eye in patients with parkinsonism. This method has advantages, including ease of application, reduced time-consumption, and requirement of minimal resources. It will also help physicians to conduct efficient diagnoses since many patients with PSP could intially present with ocular symptoms in busy outpatient clinics. Electronic supplementary material The online version of this article (10.1186/s40035-019-0160-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Onanong Phokaewvarangkul
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Miki Y, Foti SC, Asi YT, Tsushima E, Quinn N, Ling H, Holton JL. Improving diagnostic accuracy of multiple system atrophy: a clinicopathological study. Brain 2019; 142:2813-2827. [DOI: 10.1093/brain/awz189] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/06/2019] [Accepted: 04/28/2019] [Indexed: 01/22/2023] Open
Abstract
AbstractClinical diagnosis of multiple system atrophy is challenging and many patients with Lewy body disease (i.e. Parkinson’s disease or dementia with Lewy bodies) or progressive supranuclear palsy are misdiagnosed as having multiple system atrophy in life. The clinical records of 203 patients with a clinical diagnosis of multiple system atrophy were reviewed to identify diagnostic pitfalls. We also examined 12 features supporting a diagnosis of multiple system atrophy (red flag features: orofacial dystonia, disproportionate antecollis, camptocormia and/or Pisa syndrome, contractures of hands or feet, inspiratory sighs, severe dysphonia, severe dysarthria, snoring, cold hands and feet, pathological laughter and crying, jerky myoclonic postural/action tremor and polyminimyoclonus) and seven disability milestones (frequent falls, use of urinary catheters, wheelchair dependent, unintelligible speech, cognitive impairment, severe dysphagia, residential care). Of 203 cases, 160 (78.8%) were correctly diagnosed in life and had pathologically confirmed multiple system atrophy. The remaining 21.2% (43/203) had alternative pathological diagnoses including Lewy body disease (12.8%; n = 26), progressive supranuclear palsy (6.4%; n = 13), cerebrovascular diseases (1%; n = 2), amyotrophic lateral sclerosis (0.5%; n = 1) and cerebellar degeneration (0.5%; n = 1). More patients with multiple system atrophy developed ataxia, stridor, dysphagia and falls than patients with Lewy body disease; resting tremor, pill-rolling tremor and hallucinations were more frequent in Lewy body disease. Although patients with multiple system atrophy and progressive supranuclear palsy shared several symptoms and signs, ataxia and stridor were more common in multiple system atrophy. Multiple logistic regression analysis revealed increased likelihood of multiple system atrophy versus Lewy body disease and progressive supranuclear palsy if a patient developed orthostatic hypotension or urinary incontinence with the requirement for urinary catheters [multiple system atrophy versus Lewy body disease: odds ratio (OR): 2.0, 95% confidence interval (CI): 1.1–3.7, P = 0.021; multiple system atrophy versus progressive supranuclear palsy: OR: 11.2, 95% CI: 3.2–39.2, P < 0.01]. Furthermore, autonomic dysfunction within the first 3 years from onset can differentiate multiple system atrophy from progressive supranuclear palsy (multiple system atrophy versus progressive supranuclear palsy: OR: 3.4, 95% CI: 1.2–9.7, P = 0.023). Multiple system atrophy patients with predominant parkinsonian signs had a higher number of red flag features than patients with Lewy body disease (OR: 8.8, 95% CI: 3.2–24.2, P < 0.01) and progressive supranuclear palsy (OR: 4.8, 95% CI: 1.7–13.6, P < 0.01). The number of red flag features in multiple system atrophy with predominant cerebellar signs was also higher than in Lewy body disease (OR: 7.0, 95% CI: 2.5–19.5, P < 0.01) and progressive supranuclear palsy (OR: 3.1, 95% CI: 1.1–8.9, P = 0.032). Patients with multiple system atrophy had shorter latency to reach use of urinary catheter and longer latency to residential care than progressive supranuclear palsy patients, whereas patients with Lewy body disease took longer to reach multiple milestones than patients with multiple system atrophy. The present study has highlighted features which should improve the ante-mortem diagnostic accuracy of multiple system atrophy.
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Affiliation(s)
- Yasuo Miki
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London, UK
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Sandrine C Foti
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London, UK
| | - Yasmine T Asi
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London, UK
| | - Eiki Tsushima
- Department of Comprehensive Rehabilitation Science, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan
| | - Niall Quinn
- UCL Queen Square Institute of Neurology, London, UK
| | - Helen Ling
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London, UK
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London, UK
| | - Janice L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, 1 Wakefield Street, London, UK
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Oliveira MCB, Ling H, Lees AJ, Holton JL, De Pablo-Fernandez E, Warner TT. Association of autonomic symptoms with disease progression and survival in progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 2019; 90:555-561. [PMID: 30598430 DOI: 10.1136/jnnp-2018-319374] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/27/2018] [Accepted: 12/01/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Development of autonomic failure is associated with more rapid disease course and shorter survival in patients with Parkinson's disease and multiple system atrophy. However, autonomic symptoms have not been specifically assessed as a prognostic factor in progressive supranuclear palsy (PSP). We evaluated whether development of autonomic symptoms is associated with disease progression and survival in PSP. METHODS A retrospective review of clinical data from consecutive patients with autopsy-confirmed PSP from the Queen Square Brain Bank between January 2012 and November 2016 was performed. Time from disease onset to four autonomic symptoms (constipation, urinary symptoms, erectile dysfunction and orthostatic hypotension) were noted. Time from diagnosis to five disease milestones and survival were calculated to assess disease progression, and their risk was estimated through a Cox proportional hazards model. RESULTS A total of 103 PSP patients were included. Urinary symptoms and constipation were present in 81% and 71% of cases, respectively. Early development of constipation and urinary symptoms were associated with higher risk of reaching the first disease milestone (respectively, HR: 0.88; 95% CI 0.83 to 0.92; p<0.001; and HR: 0.80; 95% CI 0.75 to 0.86; p<0.001) and with a shorter survival in these patients (respectively, HR: 0.73; 95% CI 0.64 to 0.84; p<0.001; and HR: 0.88; 95% CI 0.80 to 0.96; p=0.004). On multivariate analysis, Richardson syndrome phenotype was the other variable independently associated with shorter survival. CONCLUSIONS Earlier urinary symptoms and constipation are associated with a more rapid disease progression and reduced survival in patients with PSP.
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Affiliation(s)
- Marcos C B Oliveira
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.,Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Helen Ling
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Janice L Holton
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.,Department of Molecular Neuroscience, University College London, London, UK
| | - Eduardo De Pablo-Fernandez
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Thomas T Warner
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, UK .,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK.,Department of Molecular Neuroscience, University College London, London, UK
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Quattrone A, Morelli M, Vescio B, Nigro S, Le Piane E, Sabatini U, Caracciolo M, Vescio V, Quattrone A, Barbagallo G, Stanà C, Nicoletti G, Arabia G, Nisticò R, Novellino F, Salsone M. Refining initial diagnosis of Parkinson's disease after follow-up: A 4-year prospective clinical and magnetic resonance imaging study. Mov Disord 2019; 34:487-495. [PMID: 30759325 PMCID: PMC6593994 DOI: 10.1002/mds.27621] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/27/2018] [Accepted: 01/02/2019] [Indexed: 01/05/2023] Open
Abstract
Background No prospective study of patients with Parkinson's disease (PD) has investigated the appearance of vertical gaze abnormalities, a feature suggestive of progressive supranuclear palsy (PSP). Objective To identify, within a cohort of patients with an initial diagnosis of PD, those who developed vertical gaze abnormalities during a 4‐year follow‐up, and to investigate the performance of new imaging biomarkers in predicting vertical gaze abnormalities. Methods A total of 110 patients initially classified as PD and 74 controls were enrolled. All patients underwent clinical assessment at baseline and every year up to the end of the follow‐up. The pons/midbrain area ratio 2.0 and the Magnetic Resonance Parkinsonism Index 2.0 were calculated. Results After 4‐year follow‐up, 100 of 110 patients maintained the diagnosis of PD, whereas 10 PD patients (9.1%) developed vertical gaze abnormalities, suggesting an alternative diagnosis of PSP‐parkinsonism. At baseline, the Magnetic Resonance Parkinsonism Index 2.0 was the most accurate biomarker in differentiating PD patients who developed vertical gaze abnormalities from those who maintained an initial diagnosis of PD. At the end of follow‐up, both of these biomarkers accurately distinguished PSP‐parkinsonism from PD. Conclusions Our results demonstrate that a number of patients with an initial diagnosis of PD developed vertical gaze abnormalities during a 4‐year follow‐up, and the diagnosis was changed from PD to PSP‐parkinsonism. In PD patients, baseline Magnetic Resonance Parkinsonism Index 2.0 showed the best performance in predicting the clinical evolution toward a PSP‐parkinsonism phenotype, enabling PSP‐parkinsonism patients to be identified at the earliest stage of the disease for promising disease‐modifying therapies. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Aldo Quattrone
- Neuroscience Centre, Magna Graecia University, Catanzaro, Italy.,Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Maurizio Morelli
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.,Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | | | - Salvatore Nigro
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Emilio Le Piane
- Department of Neurology, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Umberto Sabatini
- Institute of Neuroradiology, Magna Graecia University, Catanzaro, Italy
| | - Manuela Caracciolo
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Virginia Vescio
- Institute of Neuroradiology, Magna Graecia University, Catanzaro, Italy
| | - Andrea Quattrone
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Gaetano Barbagallo
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Carlo Stanà
- Institute of Neuroradiology, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Nicoletti
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Gennarina Arabia
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.,Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Rita Nisticò
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Fabiana Novellino
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Maria Salsone
- Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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32
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Cognitive and behavioural dysfunctions in a patient with progressive supranuclear palsy (PSP). HEALTH PSYCHOLOGY REPORT 2019. [DOI: 10.5114/hpr.2019.82633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BackgroundThe aim of the case study was to describe the profile of cognitive and emotional functioning of a patient with possible progressive supranuclear palsy (PSP) from a longitudinal perspective.Participants and procedureThis study involved an 71-year-old male patient diagnosed with PSP, and 9 matched healthy subjects. Neuro-psychological examination of the patient was performed twice with a 6 month interval. A set of neuropsycho-logical tests was used to assess both cognition and behaviour.ResultsNeuropsychological assessment revealed executive dysfunction dominance (planning deficits, reduced cogni-tive flexibility and abstract thinking, impulsiveness), reduced verbal fluency, psychomotor slowness and prob-lems with memory retrieval from the long-term memory storage in contrast to significantly better recognition of the previously learned information. According to emotional functioning, frontal change of personality was ob-served, with apathy, disinhibition, lack of insights, impulsiveness and “utilization behaviours”.ConclusionsThe profile of emotional and cognitive impairments met the criteria for dementia. There was a progression of deficits at visit two in comparison to visit one. The longitudinal perspective allowed the dynamics of emotional, cognitive and behavioural changes to be described over time: from depression related to initially preserved criticism of the illness to apathy and emotional blunting and behavioural frontal syndrome connected with the systematic loss of insight.
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Tan CC, Zhang XY, Tan L, Yu JT. Tauopathies: Mechanisms and Therapeutic Strategies. J Alzheimers Dis 2019; 61:487-508. [PMID: 29278892 DOI: 10.3233/jad-170187] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Tauopathies are morphologically, biochemically, and clinically heterogeneous neurodegenerative diseases defined by the accumulation of abnormal tau proteins in the brain. There is no effective method to prevent and reverse the tauopathies, but this gloomy picture has been changed by recent research advances. Evidences from genetic studies, experimental animal models, and molecular and cell biology have shed light on the main mechanisms of the diseases. The development of radiology and biochemistry, especially the development of PET imaging, will provide important biomarkers for the clinical diagnosis and treatment. Given the central role of tau in tauopathies, many treatments have constantly emerged, including targeting phosphorylation, targeting aggregation, increasing microtubule stabilization, tau immunization, clearance of tau, anti-inflammatory treatment, and other therapeutics. There is still a long way to go before we obtain drug therapy targeted at multifactor mechanisms.
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Affiliation(s)
- Chen-Chen Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong, China
| | - Xiao-Yan Zhang
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong, China
| | - Jin-Tai Yu
- Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, Shandong, China
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Bhidayasiri R, Sringean J, Reich SG, Colosimo C. Red flags phenotyping: A systematic review on clinical features in atypical parkinsonian disorders. Parkinsonism Relat Disord 2018; 59:82-92. [PMID: 30409560 DOI: 10.1016/j.parkreldis.2018.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/28/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022]
Abstract
To establish a clinical diagnosis of a parkinsonian disorder, physicians rely on their ability to identify relevant red flags, in addition to cardinal features, to support or refute their working diagnosis in an individual patient. The term 'red flag', was originally coined in 1989 to define the presence of non-cardinal features that may raise a suspicion of multiple system atrophy (MSA), or at least suggest alternative diagnosis to Parkinson's disease (PD). Since then, the term 'red flag', has been consistently used in the literature to denote the clinical history or signs that may signal to physicians the possibility of an atypical parkinsonian disorder (APD). While most red flags were originally based on expert opinion, many have gained acceptance and are now included in validated clinical diagnostic criteria of PD and APDs. The clinical appreciation of red flags, in conjunction with standard criteria, may result in a more accurate and earlier diagnosis compared to standard criteria alone. However, red flags can be clinical signs that are non-neurological, making the systematic assessment for them a real challenge in clinical practice. Here, we have conducted a systematic review to identify red flags and their clinical evidence in the differential diagnosis of common degenerative parkinsonism, including PD, MSA, progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and dementia with Lewy body (DLB). Increasing awareness and appropriate use of red flags in clinical practice may benefit physicians in the diagnosis and management of their patients with parkinsonism.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand; Department of Neurology, Juntendo University, Tokyo, Japan.
| | - Jirada Sringean
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Stephen G Reich
- Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
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35
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Quattrone A, Morelli M, Nigro S, Quattrone A, Vescio B, Arabia G, Nicoletti G, Nisticò R, Salsone M, Novellino F, Barbagallo G, Le Piane E, Pugliese P, Bosco D, Vaccaro MG, Chiriaco C, Sabatini U, Vescio V, Stanà C, Rocca F, Gullà D, Caracciolo M. A new MR imaging index for differentiation of progressive supranuclear palsy-parkinsonism from Parkinson's disease. Parkinsonism Relat Disord 2018; 54:3-8. [DOI: 10.1016/j.parkreldis.2018.07.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 12/22/2022]
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36
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The diagnostic accuracy of the hummingbird and morning glory sign in patients with neurodegenerative parkinsonism. Parkinsonism Relat Disord 2018; 54:90-94. [DOI: 10.1016/j.parkreldis.2018.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/26/2018] [Accepted: 04/01/2018] [Indexed: 11/18/2022]
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Ali F, Josephs K. The diagnosis of progressive supranuclear palsy: current opinions and challenges. Expert Rev Neurother 2018; 18:603-616. [DOI: 10.1080/14737175.2018.1489241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Keith Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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38
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Mostile G, Nicoletti A, Zappia M. Vascular Parkinsonism: Still Looking for a Diagnosis. Front Neurol 2018; 9:411. [PMID: 29962998 PMCID: PMC6013552 DOI: 10.3389/fneur.2018.00411] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/18/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giovanni Mostile
- Section of Neurosciences, Department "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Alessandra Nicoletti
- Section of Neurosciences, Department "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Mario Zappia
- Section of Neurosciences, Department "G.F. Ingrassia", University of Catania, Catania, Italy
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The reorganization of functional architecture in the early-stages of Parkinson's disease. Parkinsonism Relat Disord 2018; 50:61-68. [DOI: 10.1016/j.parkreldis.2018.02.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 01/18/2018] [Accepted: 02/07/2018] [Indexed: 01/01/2023]
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40
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Seki M, Seppi K, Mueller C, Potrusil T, Goebel G, Reiter E, Nocker M, Steiger R, Wildauer M, Gizewski ER, Wenning GK, Poewe W, Scherfler C. Diagnostic potential of dentatorubrothalamic tract analysis in progressive supranuclear palsy. Parkinsonism Relat Disord 2018; 49:81-87. [PMID: 29463454 DOI: 10.1016/j.parkreldis.2018.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/04/2018] [Accepted: 02/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The differentiation of progressive supranuclear palsy-parkinsonism (PSP-P) from Parkinson's disease (PD) remains a major clinical challenge. OBJECTIVES To evaluate the diagnostic potential of observer-independent assessments of microstructural integrity within infratentorial brain regions to differentiate PSP-Richardson's syndrome (PSP-RS), PSP-P and PD. METHODS 3T MRI parameters of mean diffusivity, fractional anisotropy, grey and white matter volumes from patients with PSP-RS (n = 12), PSP-P (n = 12) and mean disease duration of 2.4 ± 1.7 years were compared with PD patients (n = 20) and healthy controls (n = 23) by using statistical parametric mapping and the spatially unbiased infratentorial template. Subsequently MRI measurements of the dentatorubrothalamic tract were determined observer-independently by a validated probabilistic infratentorial atlas. The impairment of gait and postural stability was evaluated by a sum-score derived from the Unified Parkinson Disease Rating Scale. RESULTS Significant mean diffusivity increases, fractional anisotropy decreases and corresponding volume loss were localized in mesencephalic tegmentum, superior cerebellar peduncle, decussation of superior cerebellar peduncle and dentate nucleus in PSP-RS and PSP-P compared to PD and healthy controls. Altered microstructural integrity of the dentatorubrothalamic tract in PSP-RS was significantly more pronounced compared to PSP-P and correlated significantly with the gait and postural stability sum-score. Linear discriminant analysis identified diffusion tensor imaging measures of the dentatorubrothalamic tract and the gait and postural stability sum-score to classify correctly 95.5% of PRP-RS, PSP-P and PD patients. CONCLUSIONS Observer-independent analysis of microstructural integrity within the dentatorubrothalamic tract in combination with assessments of gait and postural stability differentiate PSP-P from PSP-RS and PD in early to moderately advanced stages.
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Affiliation(s)
- Morinobu Seki
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria.
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria
| | | | - Thomas Potrusil
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Austria
| | - Eva Reiter
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Michael Nocker
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Ruth Steiger
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria; Department of Neuroradiology, Medical University of Innsbruck, Austria
| | - Matthias Wildauer
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria; Department of Neuroradiology, Medical University of Innsbruck, Austria
| | - Elke R Gizewski
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria; Department of Neuroradiology, Medical University of Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Austria
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Mangesius S, Hussl A, Krismer F, Mahlknecht P, Reiter E, Tagwercher S, Djamshidian A, Schocke M, Esterhammer R, Wenning G, Müller C, Scherfler C, Gizewski ER, Poewe W, Seppi K. MR planimetry in neurodegenerative parkinsonism yields high diagnostic accuracy for PSP. Parkinsonism Relat Disord 2018; 46:47-55. [DOI: 10.1016/j.parkreldis.2017.10.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 10/01/2017] [Accepted: 10/30/2017] [Indexed: 12/20/2022]
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Abstract
Currently, the differential diagnosis between atypical parkinsonisms and classical idiopathic Parkinson's disease can be quite difficult because of the significant overlap of clinical presentation and symptoms. Neurodegenerative conditions, including progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and frontotemporal dementia (FTD), are primarily characterized by accumulation of tau protein in the brain. Recent imaging developments for tau pathology may provide a promising tool for the assessment of diagnosis, prognosis, and progression of these neurodegenerative disorders. This review will survey PET studies to describe the recent advances in the imaging of tau pathology in PSP, CBD, and FTD.
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Affiliation(s)
- Mikaeel Valli
- a Research Imaging Centre , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto , Toronto , ON , Canada.,b Division of Brain, Imaging and Behaviour-Systems Neuroscience , Krembil Research Institute, UHN, University of Toronto , Toronto , ON , Canada.,c Institute of Medical Science , University of Toronto , Toronto , ON , Canada
| | - Antonio P Strafella
- a Research Imaging Centre , Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto , Toronto , ON , Canada.,b Division of Brain, Imaging and Behaviour-Systems Neuroscience , Krembil Research Institute, UHN, University of Toronto , Toronto , ON , Canada.,c Institute of Medical Science , University of Toronto , Toronto , ON , Canada.,d Morton and Gloria Shulman Movement Disorder Unit & E.J. Safra Parkinson Disease Program, Neurology Division, Department of Medicine , Toronto Western Hospital, UHN, University of Toronto , Toronto , ON , Canada
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Sako W, Murakami N, Izumi Y, Kaji R. Usefulness of the superior cerebellar peduncle for differential diagnosis of progressive supranuclear palsy: A meta-analysis. J Neurol Sci 2017; 378:153-157. [PMID: 28566154 DOI: 10.1016/j.jns.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/19/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
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Boxer AL, Yu JT, Golbe LI, Litvan I, Lang AE, Höglinger GU. Advances in progressive supranuclear palsy: new diagnostic criteria, biomarkers, and therapeutic approaches. Lancet Neurol 2017; 16:552-563. [PMID: 28653647 PMCID: PMC5802400 DOI: 10.1016/s1474-4422(17)30157-6] [Citation(s) in RCA: 260] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 04/12/2017] [Accepted: 04/25/2017] [Indexed: 12/12/2022]
Abstract
Progressive supranuclear palsy (PSP), previously believed to be a common cause of atypical parkinsonism, is now recognised as a range of motor and behavioural syndromes that are associated with a characteristic 4-repeat tau neuropathology. New research criteria that recognise early presentations of PSP and operationalise diagnosis of the full spectrum of clinical phenotypes have been reported. The Movement Disorders Society PSP diagnostic criteria include syndromes with few or mild symptoms that are suggestive of underlying PSP pathology and could provide an opportunity for earlier therapeutic interventions in the future. These criteria also include definitions for variant PSP syndromes with different patterns of movement, language, or behavioural features than have been conclusively associated with PSP pathology. Data from new diagnostic biomarkers can be combined with the clinical features of disease to increase the specificity of the new criteria for underlying PSP pathology. Because PSP is associated with tau protein abnormalities, there is growing interest in clinical trials of new tau-directed therapies. These therapies are hypothesised to have disease-modifying effects by reducing the concentration of toxic forms of tau in the brain or by compensating for loss of tau function. Since tau pathology is also central to Alzheimer's disease and chronic traumatic encephalopathy, a successful tau therapeutic for PSP might inform treatment of other neurodegenerative diseases.
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Affiliation(s)
- Adam L Boxer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA.
| | - Jin-Tai Yu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lawrence I Golbe
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Irene Litvan
- Department of Neurology, University of California, San Diego, CA, USA
| | - Anthony E Lang
- Department of Neurology, University of Toronto, Toronto, ON, Canada
| | - Günter U Höglinger
- Department of Neurology, Technical University of Munich, Munich, Germany; Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; Munich Cluster for Systems Neurology SyNergy, Munich, Germany
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Hoglinger GU, Respondek G, Stamelou M, Kurz C, Josephs KA, Lang AE, Mollenhauer B, Muller U, Nilsson C, Whitwell JL, Arzberger T, Englund E, Gelpi E, Giese A, Irwin DJ, Meissner WG, Pantelyat A, Rajput A, van Swieten JC, Troakes C, Antonini A, Bhatia KP, Bordelon Y, Compta Y, Corvol JC, Colosimo C, Dickson DW, Dodel R, Ferguson L, Grossman M, Kassubek J, Krismer F, Levin J, Lorenzl S, Morris HR, Nestor P, Oertel WH, Poewe W, Rabinovici G, Rowe JB, Schellenberg GD, Seppi K, van Eimeren T, Wenning GK, Boxer AL, Golbe LI, Litvan I. Clinical diagnosis of progressive supranuclear palsy: The movement disorder society criteria. Mov Disord 2017; 32:853-864. [PMID: 28467028 PMCID: PMC5516529 DOI: 10.1002/mds.26987] [Citation(s) in RCA: 1321] [Impact Index Per Article: 188.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND PSP is a neuropathologically defined disease entity. Clinical diagnostic criteria, published in 1996 by the National Institute of Neurological Disorders and Stroke/Society for PSP, have excellent specificity, but their sensitivity is limited for variant PSP syndromes with presentations other than Richardson's syndrome. OBJECTIVE We aimed to provide an evidence- and consensus-based revision of the clinical diagnostic criteria for PSP. METHODS We searched the PubMed, Cochrane, Medline, and PSYCInfo databases for articles published in English since 1996, using postmortem diagnosis or highly specific clinical criteria as the diagnostic standard. Second, we generated retrospective standardized clinical data from patients with autopsy-confirmed PSP and control diseases. On this basis, diagnostic criteria were drafted, optimized in two modified Delphi evaluations, submitted to structured discussions with consensus procedures during a 2-day meeting, and refined in three further Delphi rounds. RESULTS Defined clinical, imaging, laboratory, and genetic findings serve as mandatory basic features, mandatory exclusion criteria, or context-dependent exclusion criteria. We identified four functional domains (ocular motor dysfunction, postural instability, akinesia, and cognitive dysfunction) as clinical predictors of PSP. Within each of these domains, we propose three clinical features that contribute different levels of diagnostic certainty. Specific combinations of these features define the diagnostic criteria, stratified by three degrees of diagnostic certainty (probable PSP, possible PSP, and suggestive of PSP). Clinical clues and imaging findings represent supportive features. CONCLUSIONS Here, we present new criteria aimed to optimize early, sensitive, and specific clinical diagnosis of PSP on the basis of currently available evidence. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gunter U. Hoglinger
- Department of Neurology, Technische Universitat Munchen, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Gesine Respondek
- Department of Neurology, Technische Universitat Munchen, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Maria Stamelou
- Second Department of Neurology, Attikon University Hospital, University of Athens, Athens, Greece
| | - Carolin Kurz
- Department of Psychiatry, Ludwig-Maximilians-Universitat, Munich, Germany
| | | | - Anthony E. Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, Toronto, Canada
| | - Brit Mollenhauer
- Paracelsus-Elena Klinik, Kassel, Germany, and University Medical Center Gottingen, Institute of Neuropathology, Gottingen, Germany
| | | | - Christer Nilsson
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | | | - Thomas Arzberger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Psychiatry, Ludwig-Maximilians-Universitat, Munich, Germany
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universitat, Munich, Germany
| | - Elisabet Englund
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Ellen Gelpi
- Neurological Tissue Bank of the Biobank - Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Armin Giese
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universitat, Munich, Germany
| | - David J. Irwin
- Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wassilios G. Meissner
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
- Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | | | - Alex Rajput
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Claire Troakes
- London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, and Department of Neurosciences, Padova University, Padova, Italy
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Yaroslau Compta
- Parkinson’s Disease & Movement Disorders Unit, Neurology Service, Hospital Clinic/IDIBAPS/University of Barcelona, Barcelona, Catalonia, Spain
| | - Jean-Christophe Corvol
- Sorbonne Universités, UPMC Univ Paris 06; and INSERM UMRS_1127, CIC_1422; and CNRS UMR_7225; and AP-HP; and ICM, Hôpital Pitié-Salpêtrière, Département des maladies du système nerveux, Paris, France
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital of Terni, Terni, Italy
| | | | - Richard Dodel
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
| | - Leslie Ferguson
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Murray Grossman
- Frontotemporal Degeneration Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Johannes Levin
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Neurology, Ludwig-Maximilians-Universitat, Munich, Germany
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Munich, Germany
| | - Huw R. Morris
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Peter Nestor
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | | | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Gil Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - James B. Rowe
- Department of Clinical Neurosciences, Cambridge University, Cambridge, United Kingdom
| | - Gerard D. Schellenberg
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Thilo van Eimeren
- Departments of Nuclear Medicine and Neurology, University of Cologne, Cologne, Germany
| | - Gregor K. Wenning
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Adam L. Boxer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - Lawrence I. Golbe
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Irene Litvan
- Department of Neurology, University of California, San Diego, California, USA
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IgLON5 autoimmunity tested negative in patients with progressive supranuclear palsy and corticobasal syndrome. Parkinsonism Relat Disord 2017; 38:102-103. [PMID: 28285943 DOI: 10.1016/j.parkreldis.2017.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/01/2017] [Accepted: 03/04/2017] [Indexed: 11/21/2022]
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Krismer F, Pinter B, Mueller C, Mahlknecht P, Nocker M, Reiter E, Djamshidian-Tehrani A, Boesch SM, Wenning GK, Scherfler C, Poewe W, Seppi K. Sniffing the diagnosis: Olfactory testing in neurodegenerative parkinsonism. Parkinsonism Relat Disord 2016; 35:36-41. [PMID: 27890451 DOI: 10.1016/j.parkreldis.2016.11.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 10/19/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the diagnostic utility of olfactory testing in patients with neurodegenerative parkinsonism. METHODS The Sniffin' Sticks test battery for assessment of odor identification, discrimination, and threshold was applied to patients with Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) as well as healthy controls (HC). Two different cohorts were analyzed: A PD/healthy control that included PD patients and HC as well as a PD/diseased control cohort for which patients PD, MSA and PSP were recruited. The former cohort was exploited to calculate cut-off values that discriminate PD patients from HC with a sensitivity (sensitivity-weighted cut-off) or specificity (specificity-weighted cut-off) exceeding 95%, respectively. The PD/diseased controls cohort was used to determine the diagnostic accuracy using these cut-off values in discriminating patients with neurodegenerative parkinsonism. RESULTS PD patients (n = 67) performed significantly worse in olfactory testing than HC (n = 41) and patients with MSA (n = 23) or PSP (n = 23). There was no significant difference in olfactory function between MSA and PSP patients. Diagnostic performance of the identification subscore was similar to the sum score of the Sniffin' Sticks test (AUC identification test 0.94, AUC sum score 0.96), while threshold and discrimination subscores were inferior. In patients with parkinsonism, the specificity-weighted cut-off predicted a diagnosis of PD with a sensitivity and specificity of 76.6 and 87.0%, respectively. The discriminative value of this cut-off in separating PD from MSA was 76.7% (sensitivity) and 95.7% (specificity). The corresponding, prevalence-adjusted positive predictive value of olfactory testing exceeded 95%. CONCLUSIONS Our data suggest that assessment of olfactory function, particularly odor identification, can be useful to discriminate PD from atypical parkinsonian disorders, particularly MSA patients.
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Affiliation(s)
- F Krismer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - B Pinter
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - C Mueller
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - P Mahlknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Nocker
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - E Reiter
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - S M Boesch
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - G K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - C Scherfler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - W Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - K Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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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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49
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Hwang M, Yang H, Kim Y, Youn J, Park J, Huh YE, Kim HT, Cho JW. Differential Progression of Midbrain Atrophy in Parkinsonism: Longitudinal MRI Study. NEURODEGENER DIS 2016; 17:31-37. [PMID: 27614955 DOI: 10.1159/000448174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/04/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS To elucidate different patterns of progression of midbrain atrophy in patients with Richardson's syndrome (RS), progressive supranuclear palsy-parkinsonism (PSP-P), and Parkinson's disease (PD) using magnetic resonance imaging (MRI)-based visual rating indexes. METHODS We recruited 12 patients with PSP-RS, 12 with PSP-P, and 23 with PD for whom MRIs had been followed up for at least 2 years (mean ± SD, 4.9 ± 1.6 years) after the initial MRI. MRI-based visual rating indexes were used to estimate midbrain atrophy, including the ratio of the pontine to midbrain tegmental areas (P/M ratio) on a midsagittal image, the length between the interpeduncular fossa and the center of the cerebral aqueduct at the midmammillary-body level (MTEGM) on axial images, and the morning glory sign. RESULTS Initially, there were no differences in MRI-based visual rating indexes between PSP-P and PD, while PSP-RS showed a higher P/M ratio and lower MTEGM compared with PSP-P and PD. In PD, the P/M ratio and MTEGM remained stable with disease progression. However, the extent of changes between initial and follow-up indexes was similarly greater for both PSP-RS and PSP-P than for PD. Finally, PSP-P showed a higher P/M ratio and lower MTEGM compared with PD in the follow-up, while PSP-RS still exhibited the most profound changes. CONCLUSIONS Midbrain atrophy progresses differentially in patients with PSP-RS, PSP-P, and PD. Longitudinal measurements of midbrain atrophy using MRI-based visual rating indexes can help distinguish patients with PSP-P from those with PSP-RS and PD.
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Affiliation(s)
- Minho Hwang
- Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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50
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Quattrone A, Morelli M, Williams DR, Vescio B, Arabia G, Nigro S, Nicoletti G, Salsone M, Novellino F, Nisticò R, Pucci F, Chiriaco C, Pugliese P, Bosco D, Caracciolo M. MR parkinsonism index predicts vertical supranuclear gaze palsy in patients with PSP-parkinsonism. Neurology 2016; 87:1266-73. [PMID: 27558375 PMCID: PMC5035983 DOI: 10.1212/wnl.0000000000003125] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/07/2016] [Indexed: 11/15/2022] Open
Abstract
Objective: To identify a biomarker for predicting the appearance of vertical supranuclear gaze palsy (VSGP) in patients affected by progressive supranuclear palsy–parkinsonism (PSP-P). Methods: Twenty-four patients with PSP-P were enrolled in the current study. Patients were clinically followed up every 6 months until the appearance of VSGP or the end of the follow-up (4 years). Participants underwent MRI at baseline and at the end of follow-up. Magnetic resonance parkinsonism index (MRPI), an imaging measure useful for diagnosing PSP, was calculated. Results: Twenty-one patients with PSP-P completed follow-up, and 3 patients dropped out. Eleven of 21 patients with PSP-P developed VSGP after a mean follow-up period of 28.5 months (range 6–48 months), while the remaining 10 patients with PSP-P did not develop VSGP during the 4-year follow-up period. At baseline, patients with PSP-P who later developed VSGP had MRPI values significantly higher than those of patients not developing VSGP without overlapping values between the 2 groups. MRPI showed a higher accuracy (100%) in predicting VSGP than vertical ocular slowness (accuracy 33.3%) or postural instability with or without vertical ocular slowness (accuracy 71.4% and 42.9%, respectively). Conclusions: Our study demonstrates that MRPI accurately predicted, on an individual basis, the appearance of VSGP in patients with PSP-P, thus confirming clinical diagnosis in vivo.
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Affiliation(s)
- Aldo Quattrone
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy.
| | - Maurizio Morelli
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
| | - David R Williams
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
| | - Basilio Vescio
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
| | - Gennarina Arabia
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
| | - Salvatore Nigro
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
| | - Giuseppe Nicoletti
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
| | - Maria Salsone
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
| | - Fabiana Novellino
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
| | - Rita Nisticò
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
| | - Franco Pucci
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
| | - Carmelina Chiriaco
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
| | - Pierfrancesco Pugliese
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
| | - Domenico Bosco
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
| | - Manuela Caracciolo
- From the Institute of Neurology (A.Q., M.M., G.A., F.P.), Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology (A.Q., B.V., S.N., G.N., M.S., F.N., R.N., C.C., M.C.), National Research Council, Catanzaro, Italy; Department of Medicine (Neuroscience) (D.R.W.), Monash University, Melbourne, Australia; Neurology Unit (P.P.), Annunziata Hospital, Cosenza, Italy; and Department of Neuroscience (D.B.), San Giovanni di Dio Hospital, Crotone, Italy
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