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Silva RH, Lopes-Silva LB, Cunha DG, Becegato M, Ribeiro AM, Santos JR. Animal Approaches to Studying Risk Factors for Parkinson's Disease: A Narrative Review. Brain Sci 2024; 14:156. [PMID: 38391730 PMCID: PMC10887213 DOI: 10.3390/brainsci14020156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Despite recent efforts to search for biomarkers for the pre-symptomatic diagnosis of Parkinson's disease (PD), the presence of risk factors, prodromal signs, and family history still support the classification of individuals at risk for this disease. Human epidemiological studies are useful in this search but fail to provide causality. The study of well-known risk factors for PD in animal models can help elucidate mechanisms related to the disease's etiology and contribute to future prevention or treatment approaches. This narrative review aims to discuss animal studies that investigated four of the main risk factors and/or prodromal signs related to PD: advanced age, male sex, sleep alterations, and depression. Different databases were used to search the studies, which were included based on their relevance to the topic. Although still in a reduced number, such studies are of great relevance in the search for evidence that leads to a possible early diagnosis and improvements in methods of prevention and treatment.
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Affiliation(s)
- R H Silva
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo, São Paulo 04021-001, SP, Brazil
| | - L B Lopes-Silva
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo, São Paulo 04021-001, SP, Brazil
| | - D G Cunha
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo, São Paulo 04021-001, SP, Brazil
| | - M Becegato
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo, São Paulo 04021-001, SP, Brazil
| | - A M Ribeiro
- Laboratory of Neuroscience and Bioprospecting of Natural Products, Department of Biosciences, Universidade Federal de São Paulo, Santos 11015-020, SP, Brazil
| | - J R Santos
- Behavioral and Evolutionary Neurobiology Laboratory, Department of Biosciences, Federal University of Sergipe, Itabaiana 49500-000, SE, Brazil
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Beauchamp LC, Dore V, Villemagne VL, Xu S, Finkelstein D, Barnham KJ, Rowe C. Using 18F-AV-133 VMAT2 PET Imaging to Monitor Progressive Nigrostriatal Degeneration in Parkinson Disease. Neurology 2023; 101:e2314-e2324. [PMID: 37816639 PMCID: PMC10727223 DOI: 10.1212/wnl.0000000000207748] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are limited validated biomarkers in Parkinson disease (PD) which substantially hinders the ability to monitor disease progression and consequently measure the efficacy of disease-modifying treatments. Imaging biomarkers, such as vesicular monoamine transporter type 2 (VMAT2) PET, enable enhanced diagnostic accuracy and detect early neurodegenerative changes associated with prodromal PD. This study sought to assess whether 18F-AV-133 VMAT2 PET is sensitive enough to monitor and quantify disease progression over a 2-year window. METHODS 18F-AV-133 PET scans were performed on participants with PD and REM sleep behavior disorder (RBD) and neurologic controls (NC). All participants were scanned twice ∼26 months apart. Regional tracer retention was calculated with a primary visual cortex reference region and expressed as the standard uptake volume ratio. Regions of interest included caudate, anterior, and posterior putamen. At the time of scanning, participants underwent clinical evaluation including UPDRSMOTOR test, Sniffin' Sticks, and Hospital Anxiety and Depression Score. RESULTS Over the 26-month interval, a significant decline in PET signal was observed in all 3 regions in participants with PD (N = 26) compared with NC (N = 12), consistent with a decrease in VMAT2 level and ongoing neurodegeneration. Imaging trajectory calculations suggest that the neurodegeneration in PD occurs over ∼33 years [CI: 27.2-39.5], with ∼10.5 years [CI: 9.1-11.3] of degeneration in the posterior putamen before it becomes detectable on a VMAT2 PET scan, a further ∼6.5 years [CI: 1.6-12.7] until symptom onset, and a further ∼3 years [CI: 0.3-8.7] until clinical diagnosis. DISCUSSION Over a 2-year period, 18F-AV-133 VMAT2 PET was able to detect progression of nigrostriatal degeneration in participants with PD, and it represents a sensitive tool to identify individuals at risk of progression to PD, which are currently lacking using clinical readouts. Trajectory models propose that there is nigrostriatal degeneration occurring for 20 years before clinical diagnosis. These data demonstrate that VMAT2 PET provides a sensitive measure to monitor neurodegenerative progression of PD which has implications for PD diagnostics and subsequently clinical trial patient stratification and monitoring. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that VMAT2 PET can detect patients with Parkinson disease and quantify progression over a 2-year window.
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Affiliation(s)
- Leah C Beauchamp
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - Vincent Dore
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - Victor L Villemagne
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - SanSan Xu
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - David Finkelstein
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
| | - Kevin J Barnham
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia.
| | - Christopher Rowe
- From the The Florey Institute of Neuroscience and Mental Health (L.C.B., D.F., K.J.B.); Health & Biosecurity Flagship (V.D.), The Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation; Department of Psychiatry (V.L.V.), University of Pittsburgh, PA; Department of Neurology (S.X.), Austin Health, Melbourne; The University of Melbourne (D.F.); Department of Molecular Imaging and Therapy (C.R.), Austin Health, Melbourne, Australia
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Schließer P, Struebing FL, Northoff BH, Kurz A, Rémi J, Holdt L, Höglinger GU, Herms J, Koeglsperger T. Detection of a Parkinson's Disease-Specific MicroRNA Signature in Nasal and Oral Swabs. Mov Disord 2023; 38:1706-1715. [PMID: 37382573 DOI: 10.1002/mds.29515] [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: 02/17/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Biomaterials from oral and nasal swabs provide, in theory, a potential resource for biomarker development. However, their diagnostic value has not yet been investigated in the context of Parkinson's disease (PD) and associated conditions. OBJECTIVE We have previously identified a PD-specific microRNA (miRNA) signature in gut biopsies. In this work, we aimed to investigate the expression of miRNAs in routine buccal (oral) and nasal swabs obtained from cases with idiopathic PD and isolated rapid eye movement sleep behavior disorder (iRBD), a prodromal symptom that often precedes α-synucleinopathies. We aimed to address their value as a diagnostic biomarker for PD and their mechanistic contribution to PD onset and progression. METHODS Healthy control cases (n = 28), cases with PD (n = 29), and cases with iRBD (n = 8) were prospectively recruited to undergo routine buccal and nasal swabs. Total RNA was extracted from the swab material, and the expression of a predefined set of miRNAs was quantified by quantitative real-time polymerase chain reaction. RESULTS Statistical analysis revealed a significantly increased expression of hsa-miR-1260a in cases who had PD. Interestingly, hsa-miR-1260a expression levels correlated with diseases severity, as well as olfactory function, in the PD and iRBD cohorts. Mechanistically, hsa-miR-1260a segregated to Golgi-associated cellular processes with a potential role in mucosal plasma cells. Predicted hsa-miR-1260a target gene expression was reduced in iRBD and PD groups. CONCLUSIONS Our work demonstrates oral and nasal swabs as a valuable biomarker pool in PD and associated neurodegenerative conditions. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Patricia Schließer
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Felix L Struebing
- Department of Translational Brain Research, German Centre for Neurodegenerative Diseases, Munich, Germany
- Center for Neuropathology and Prion Research, Ludwig Maximilian University, Munich, Germany
| | - Bernd H Northoff
- Institute of Laboratory Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anna Kurz
- Department of Gynaecology and Obstetrics, Klinikum Landsberg am Lech, Landsberg, Germany
| | - Jan Rémi
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Lesca Holdt
- Institute of Laboratory Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Günter U Höglinger
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases e.V. (DZNE) Munich, Munich, Germany
| | - Jochen Herms
- Department of Translational Brain Research, German Centre for Neurodegenerative Diseases, Munich, Germany
- Center for Neuropathology and Prion Research, Ludwig Maximilian University, Munich, Germany
| | - Thomas Koeglsperger
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Translational Brain Research, German Centre for Neurodegenerative Diseases, Munich, Germany
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Simonet C, Mahlknecht P, Marini K, Seppi K, Gill A, Bestwick JP, Lees AJ, Giovannoni G, Schrag A, Noyce AJ. The Emergence and Progression of Motor Dysfunction in Individuals at Risk of Parkinson's Disease. Mov Disord 2023; 38:1636-1644. [PMID: 37317903 DOI: 10.1002/mds.29496] [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: 03/08/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND PREDICT-PD is a United Kingdom population-based study aiming to stratify individuals for future Parkinson's disease (PD) using a risk algorithm. METHODS A randomly selected, representative sample of participants in PREDICT-PD were examined using several motor assessments, including the motor section of the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS)-III, at baseline (2012) and after an average of 6 years of follow-up. We checked for new PD diagnoses in participants seen at baseline and examined the association between risk scores and incident sub-threshold parkinsonism, motor decline (increasing ≥5 points in MDS-UPDRS-III) and single motor domains in the MDS-UPDRS-III. We replicated analyses in two independent datasets (Bruneck and Parkinson's Progression Markers Initiative [PPMI]). RESULTS After 6 years of follow-up, the PREDICT-PD higher-risk group (n = 33) had a greater motor decline compared with the lower-risk group (n = 95) (30% vs. 12.5%, P = 0.031). Two participants (both considered higher risk at baseline) were given a diagnosis of PD during follow-up, with motor signs emerging between 2 and 5 years before diagnosis. A meta-analysis of data from PREDICT-PD, Bruneck, and PPMI showed an association between PD risk estimates and incident sub-threshold parkinsonism (odds ratio [OR], 2.01 [95% confidence interval (CI), 1.55-2.61]), as well as new onset bradykinesia (OR, 1.69 [95% CI, 1.33-2.16]) and action tremor (OR, 1.61 [95% CI, 1.30-1.98]). CONCLUSIONS Risk estimates using the PREDICT-PD algorithm were associated with the occurrence of sub-threshold parkinsonism, including bradykinesia and action tremor. The algorithm could also identify individuals whose motor examination experience a decline over time. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Cristina Simonet
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Philipp Mahlknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Kathrin Marini
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Aneet Gill
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Jonathan P Bestwick
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Gavin Giovannoni
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- Blizard Institute, Queen Mary University, London, United Kingdom
| | - Anette Schrag
- Reta Lila Weston Institute of Neurological Studies, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Zeng W, Wang Y, Liu L, Wu Y, Xu Y, Zhai H, Yang X, Cao X, Xu Y. Clinical characteristics and reaction to dopaminergic treatment of drug-naïve patients with Parkinson's disease in central China: A cross sectional study. Heliyon 2023; 9:e18081. [PMID: 37483764 PMCID: PMC10362235 DOI: 10.1016/j.heliyon.2023.e18081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/11/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023] Open
Abstract
Background The symptoms of early Parkinson's disease (PD) are complex and hidden. The aim of this study is to explore and summarize the characteristics of the symptoms of drug naïve patients with PD. Objectives and Methods Drug-naïve patients with PD and age-matched healthy controls were recruited from the outpatient clinic of Wuhan Union Hospital. The motor and non-motor symptoms were evaluated for further analysis using Unified Parkinson's Disease Rating Scale (UPDRS) I, II, and III; Sniffin' Sticks Screening 12 test; Mini-Mental State Exam (MMSE); Montreal Cognitive Assessment (MoCA); Hamilton Anxiety Scale (HAMA); and Hamilton Depression Scale (HAMD) scores. The acute levodopa challenge test (ALCT) was adopted to assess the reaction to dopaminergic treatment. Results We recruited 80 drug-naïve patients with PD and 40 age-matched healthy controls (HCs). Approximately 53.7% of the patients were females. The mean onset age was 59.96 ± 10.40 years. The mean UPDRS I, II, and III were 2.01 ± 1.90, 6.18 ± 3.68, and 26.13 ± 12.09, respectively. Compared with HCs, PD patients had lower scores in MMSE and MoCA; and higher scores in HAMA and HAMD (p < 0.05). In ALCT, 54 patients showed good responses to levodopa while 26 patients did not. The mean improvement rate of UPDRS III was 34.09% at 120 min. Conclusion The motor symptoms of patients with early PD were mild but virous. They also suffered from different non-motor symptoms. In ALCT, about two thirds of patients (54/80) with early PD showed good response to levodopa. Among four aspects of motor symptoms, bradykinesia reacted best to ALCT, while axial symptoms were the worst.
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Affiliation(s)
- Weiqi Zeng
- Department of Neurology, The First People's Hospital of Foshan, Foshan, Guangdong, China
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yukai Wang
- Department of Neurology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Ling Liu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Wu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Zhai
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoman Yang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuebing Cao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Koeglsperger T, Rumpf SL, Schließer P, Struebing FL, Brendel M, Levin J, Trenkwalder C, Höglinger GU, Herms J. Neuropathology of incidental Lewy body & prodromal Parkinson's disease. Mol Neurodegener 2023; 18:32. [PMID: 37173733 PMCID: PMC10182593 DOI: 10.1186/s13024-023-00622-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a progressive neurodegenerative disorder associated with a loss of dopaminergic (DA) neurons. Despite symptomatic therapies, there is currently no disease-modifying treatment to halt neuronal loss in PD. A major hurdle for developing and testing such curative therapies results from the fact that most DA neurons are already lost at the time of the clinical diagnosis, rendering them inaccessible to therapy. Understanding the early pathological changes that precede Lewy body pathology (LBP) and cell loss in PD will likely support the identification of novel diagnostic and therapeutic strategies and help to differentiate LBP-dependent and -independent alterations. Several previous studies identified such specific molecular and cellular changes that occur prior to the appearance of Lewy bodies (LBs) in DA neurons, but a concise map of such early disease events is currently missing. METHODS Here, we conducted a literature review to identify and discuss the results of previous studies that investigated cases with incidental Lewy body disease (iLBD), a presumed pathological precursor of PD. RESULTS Collectively, our review demonstrates numerous cellular and molecular neuropathological changes occurring prior to the appearance of LBs in DA neurons. CONCLUSIONS Our review provides the reader with a summary of early pathological events in PD that may support the identification of novel therapeutic and diagnostic targets and aid to the development of disease-modifying strategies in PD.
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Affiliation(s)
- Thomas Koeglsperger
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
- Department of Translational Brain Research, DZNE-German Center for Neurodegenerative Diseases, 81377, Munich, Germany.
| | - Svenja-Lotta Rumpf
- Department of Translational Brain Research, DZNE-German Center for Neurodegenerative Diseases, 81377, Munich, Germany
| | - Patricia Schließer
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Felix L Struebing
- Department of Translational Brain Research, DZNE-German Center for Neurodegenerative Diseases, 81377, Munich, Germany
- Centre for Neuropathology and Prion Research, LMU Munich, Munich, Germany
| | - Matthias Brendel
- Department of Translational Brain Research, DZNE-German Center for Neurodegenerative Diseases, 81377, Munich, Germany
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377, Munich, Germany
| | - Johannes Levin
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377, Munich, Germany
- Clinical Study Unit, DZNE - German Center for Neurodegenerative Diseases, 81377, Munich, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Center Goettingen, Goettingen, Germany
| | - Günter U Höglinger
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Neurology, Medizinische Hochschule Hannover (MHH), Hannover, Germany
| | - Jochen Herms
- Department of Translational Brain Research, DZNE-German Center for Neurodegenerative Diseases, 81377, Munich, Germany
- Centre for Neuropathology and Prion Research, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377, Munich, Germany
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Chahine LM, Simuni T. Role of novel endpoints and evaluations of response in Parkinson disease. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:325-345. [PMID: 36803820 DOI: 10.1016/b978-0-323-85555-6.00010-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
With progress in our understanding of Parkinson disease (PD) and other neurodegenerative disorders, from clinical features to imaging, genetic, and molecular characterization comes the opportunity to refine and revise how we measure these diseases and what outcome measures are used as endpoints in clinical trials. While several rater-, patient-, and milestone-based outcomes for PD exist that may serve as clinical trial endpoints, there remains an unmet need for endpoints that are clinically meaningful, patient centric while also being more objective and quantitative, less susceptible to effects of symptomatic therapy (for disease-modification trials), and that can be measured over a short period and yet accurately represent longer-term outcomes. Several novel outcomes that may be used as endpoints in PD clinical trials are in development, including digital measures of signs and symptoms, as well a growing array of imaging and biospecimen biomarkers. This chapter provides an overview of the state of PD outcome measures as of 2022, including considerations for selection of clinical trial endpoints in PD, advantages and limitations of existing measures, and emerging potential novel endpoints.
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Affiliation(s)
- Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
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Rajan S, Kaas B. Parkinson's Disease: Risk Factor Modification and Prevention. Semin Neurol 2022; 42:626-638. [PMID: 36427528 DOI: 10.1055/s-0042-1758780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The global burden of Parkinson's disease (PD) has increased from 2.5 to 6.1 million since the 1990s. This is expected to rise as the world population ages and lives longer. With the current consensus on the existence of a prediagnostic phase of PD, which can be divided into a preclinical stage and a prodromal stage, we can better define the risk markers and prodromal markers of PD in the broader context of PD pathogenesis. Here, we review this pathogenetic process, and discuss the evidence behind various heritability factors, exposure to pesticides and farming, high dairy consumption, and traumatic brain injuries that have been known to raise PD risk. Physical activity, early active lifestyle, high serum uric acid, caffeine consumption, exposure to tobacco, nonsteroidal anti-inflammatory drugs, and calcium channel blockers, as well as the Mediterranean and the MIND diets are observed to lower PD risk. This knowledge, when combined with ways to identify at-risk populations and early prodromal PD patients, can help the clinician make practical recommendations. Most importantly, it helps us set the parameters for epidemiological studies and create the paradigms for clinical trials.
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Affiliation(s)
- Suraj Rajan
- Division of Movement Disorders, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bonnie Kaas
- Division of Movement Disorders, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Liepelt-Scarfone I, Ophey A, Kalbe E. Cognition in prodromal Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:93-111. [PMID: 35248208 DOI: 10.1016/bs.pbr.2022.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
One characteristic of Parkinson's disease (PD) is a prodromal phase, lasting many years during which both pre-clinical motor and non-motor symptoms occur. Around one-fifth of patients with PD manifest mild cognitive impairment at time of clinical diagnosis. Thus, important challenges are to define the time of onset of cognitive dysfunction in the prodromal phase of PD, and to define its co-occurrence with other specific characteristics. Evidence for cognitive change in prodromal PD comes from various study designs, including both longitudinal and cross-sectional approaches with different target groups. These studies support the concept that changes in global cognitive function and alterations in executive functions occur, and that these changes may be present up to 6 years before clinical PD diagnosis. Notably, this evidence led to including global cognitive impairment as an independent prodromal marker in the recently updated research criteria of the Movement Disorder Society for prodromal PD. Knowledge in this field, however, is still at its beginning, and evidence is sparse about many aspects of this topic. Further longitudinal studies including standardized assessments of global and domain-specific cognitive functions are needed to gain further knowledge about the first appearance, the course, and the interaction of cognitive deficits with other non-motor symptoms in prodromal stage PD. Treatment approaches, including non-pharmacological interventions, in individuals with prodromal PD might help to prevent or delay cognitive dysfunction in early PD.
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Affiliation(s)
- Inga Liepelt-Scarfone
- German Center for Neurodegenerative Diseases (DZNE) and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany; IB-Hochschule, Stuttgart, Germany.
| | - Anja Ophey
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne and Medical Faculty of the University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne and Medical Faculty of the University of Cologne, Cologne, Germany
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10
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Mahlknecht P, Marini K, Werkmann M, Poewe W, Seppi K. Prodromal Parkinson's disease: hype or hope for disease-modification trials? Transl Neurodegener 2022; 11:11. [PMID: 35184752 PMCID: PMC8859908 DOI: 10.1186/s40035-022-00286-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/01/2022] [Indexed: 12/24/2022] Open
Abstract
The ultimate goal in Parkinson's disease (PD) research remains the identification of treatments that are capable of slowing or even halting the progression of the disease. The failure of numerous past disease-modification trials in PD has been attributed to a variety of factors related not only to choosing wrong interventions, but also to using inadequate trial designs and target populations. In patients with clinically established PD, neuronal pathology may already have advanced too far to be modified by any intervention. Based on such reasoning, individuals in yet prediagnostic or prodromal disease stages, may provide a window of opportunity to test disease-modifying strategies. There is now sufficient evidence from prospective studies to define diagnostic criteria for prodromal PD and several approaches have been studied in observational cohorts. These include the use of PD-risk algorithms derived from multiple established risk factors for disease as well as follow-up of cohorts with single defined prodromal markers like hyposmia, rapid eye movement sleep behavior disorders, or PD gene carriers. In this review, we discuss recruitment strategies for disease-modification trials in various prodromal PD cohorts, as well as potential trial designs, required trial durations, and estimated sample sizes. We offer a concluding outlook on how the goal of implementing disease-modification trials in prodromal cohorts might be achieved in the future.
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11
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Goodwin GR, Bestwick JP, Noyce AJ. The potential utility of smell testing to screen for neurodegenerative disorders. Expert Rev Mol Diagn 2022; 22:139-148. [PMID: 35129037 DOI: 10.1080/14737159.2022.2037424] [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: 11/04/2022]
Abstract
INTRODUCTION Loss of smell is a common early feature of neurodegenerative diseases including Alzheimer's and Parkinson's disease. Identifying these conditions in their early stages is important to understand more about early pathophysiological events and the development of disease modifying therapies. Smell testing may be an effective future tool for screening large populations for early neurodegeneration. AREAS COVERED : In this review, we appraise the evidence for, and discuss the likelihood of, the use of smell testing in large screening programs to detect early neurodegeneration. We evaluate the predictive power of smell tests for neurodegenerative disease, compare performance to other established screening programs, and discuss ethical and practical considerations and limitations. EXPERT OPINION : Even if disease modifying therapies were available for neurodegenerative disease, smell tests alone are unlikely to have high enough predictive power to be used in a future screening program. However, we believe they could be a valuable component of a short battery of tests or part of a stepwise process that together could more accurately identify early neurodegeneration in large populations.
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Affiliation(s)
- Gregory R Goodwin
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 4NS, UK
| | - Jonathan P Bestwick
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 4NS, UK
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 4NS, UK
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12
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Motor and non-motor circuit disturbances in early Parkinson disease: which happens first? Nat Rev Neurosci 2022; 23:115-128. [PMID: 34907352 DOI: 10.1038/s41583-021-00542-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 12/15/2022]
Abstract
For the last two decades, pathogenic concepts in Parkinson disease (PD) have revolved around the toxicity and spread of α-synuclein. Thus, α-synuclein would follow caudo-rostral propagation from the periphery to the central nervous system, first producing non-motor manifestations (such as constipation, sleep disorders and hyposmia), and subsequently impinging upon the mesencephalon to account for the cardinal motor features before reaching the neocortex as the disease evolves towards dementia. This model is the prevailing theory of the principal neurobiological mechanism of disease. Here, we scrutinize the temporal evolution of motor and non-motor manifestations in PD and suggest that, even though the postulated bottom-up mechanisms are likely to be involved, early involvement of the nigrostriatal system is a key and prominent pathophysiological mechanism. Upcoming studies of detailed clinical manifestations with newer neuroimaging techniques will allow us to more closely define, in vivo, the role of α-synuclein aggregates with respect to neuronal loss during the onset and progression of PD.
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13
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Dauer Née Joppe K, Tatenhorst L, Caldi Gomes L, Zhang S, Parvaz M, Carboni E, Roser AE, El DeBakey H, Bähr M, Vogel-Mikuš K, Wang Ip C, Becker S, Zweckstetter M, Lingor P. Brain iron enrichment attenuates α-synuclein spreading after injection of preformed fibrils. J Neurochem 2021; 159:554-573. [PMID: 34176164 DOI: 10.1111/jnc.15461] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/12/2022]
Abstract
Regional iron accumulation and α-synuclein (α-syn) spreading pathology within the central nervous system are common pathological findings in Parkinson's disease (PD). Whereas iron is known to bind to α-syn, facilitating its aggregation and regulating α-syn expression, it remains unclear if and how iron also modulates α-syn spreading. To elucidate the influence of iron on the propagation of α-syn pathology, we investigated α-syn spreading after stereotactic injection of α-syn preformed fibrils (PFFs) into the striatum of mouse brains after neonatal brain iron enrichment. C57Bl/6J mouse pups received oral gavage with 60, 120, or 240 mg/kg carbonyl iron or vehicle between postnatal days 10 and 17. At 12 weeks of age, intrastriatal injections of 5-µg PFFs were performed to induce seeding of α-syn aggregates. At 90 days post-injection, PFFs-injected mice displayed long-term memory deficits, without affection of motor behavior. Interestingly, quantification of α-syn phosphorylated at S129 showed reduced α-syn pathology and attenuated spreading to connectome-specific brain regions after brain iron enrichment. Furthermore, PFFs injection caused intrastriatal microglia accumulation, which was alleviated by iron in a dose-dependent way. In primary cortical neurons in a microfluidic chamber model in vitro, iron application did not alter trans-synaptic α-syn propagation, possibly indicating an involvement of non-neuronal cells in this process. Our study suggests that α-syn PFFs may induce cognitive deficits in mice independent of iron. However, a redistribution of α-syn aggregate pathology and reduction of striatal microglia accumulation in the mouse brain may be mediated via iron-induced alterations of the brain connectome.
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Affiliation(s)
- Karina Dauer Née Joppe
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
- Center for Biostructural Imaging of Neurodegeneration, University Medical Center Goettingen, Goettingen, Germany
| | - Lars Tatenhorst
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
- Center for Biostructural Imaging of Neurodegeneration, University Medical Center Goettingen, Goettingen, Germany
| | - Lucas Caldi Gomes
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
- Center for Biostructural Imaging of Neurodegeneration, University Medical Center Goettingen, Goettingen, Germany
- Department of Neurology, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Shuyu Zhang
- Department of Neurology, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Mojan Parvaz
- Department of Neurology, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Eleonora Carboni
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Anna-Elisa Roser
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
- Center for Biostructural Imaging of Neurodegeneration, University Medical Center Goettingen, Goettingen, Germany
| | - Hazem El DeBakey
- Department of Neurology, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Mathias Bähr
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
- Center for Biostructural Imaging of Neurodegeneration, University Medical Center Goettingen, Goettingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Goettingen, Goettingen, Germany
| | - Katarina Vogel-Mikuš
- Biotechnical faculty, University of Ljubljana, Ljubljana, Slovenia
- Jozef Stefan Institute, Ljubljana, Slovenia
| | - Chi Wang Ip
- Department of Neurology, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Stefan Becker
- Department of NMR Based Structural Biology, Max Planck Institute for Biophysical Chemistry, Goettingen, Germany
| | - Markus Zweckstetter
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany
- Research group Mass Spectrometry, Max Planck Institute for Biophysical Chemistry, Goettingen, Germany
| | - Paul Lingor
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
- Center for Biostructural Imaging of Neurodegeneration, University Medical Center Goettingen, Goettingen, Germany
- Department of Neurology, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
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14
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Persons AL, Bradaric BD, Kelly LP, Kousik SM, Graves SM, Yamamoto BK, Napier TC. Gut and brain profiles that resemble pre-motor and early-stage Parkinson's disease in methamphetamine self-administering rats. Drug Alcohol Depend 2021; 225:108746. [PMID: 34098381 PMCID: PMC8483557 DOI: 10.1016/j.drugalcdep.2021.108746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Methamphetamine is a potent psychomotor stimulant, and methamphetamine abusers are up to three times more likely to develop Parkinson's disease (PD) later in life. Prodromal PD may involve gut inflammation and the accumulation of toxic proteins that are transported from the enteric nervous system to the central nervous system to mediate, in part, the degeneration of dopaminergic projections. We hypothesized that self-administration of methamphetamine in rats produces a gut and brain profile that mirrors pre-motor and early-stage PD. METHODS Rats self-administered methamphetamine in daily 3 h sessions for two weeks. Motor function was assessed before self-administration, during self-administration and throughout the 56 days of forced abstinence. Assays for pathogenic markers (tyrosine hydroxylase, glial fibrillary acidic protein (GFAP), α-synuclein) were conducted on brain and gut tissue collected at one or 56 days after cessation of methamphetamine self-administration. RESULTS Motor deficits emerged by day 14 of forced abstinence and progressively worsened up to 56 days of forced abstinence. In the pre-motor stage, we observed increased immunoreactivity for GFAP and α-synuclein within the ganglia of the myenteric plexus in the distal colon. Increased α-synuclein was also observed in the substantia nigra pars compacta. At 56 days, GFAP and α-synuclein normalized in the gut, but the accumulation of nigral α-synuclein persisted, and the dorsolateral striatum exhibited a significant loss of tyrosine hydroxylase. CONCLUSION The pre-motor profile is consistent with gut inflammation and gut/brain α-synuclein accumulation associated with prodromal PD and the eventual development of the neurological disease.
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Affiliation(s)
- Amanda L. Persons
- Department of Pharmacology, Rush University Medical Center, Chicago, IL 60612,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612,Department of Physician Assistant Studies, Rush University Medical Center, Chicago, IL 60612,Department of Center for Compulsive Behavior and Addiction, Rush University Medical Center, Chicago, IL 60612
| | - Brinda D. Bradaric
- Department of Pharmacology, Rush University Medical Center, Chicago, IL 60612,Department of Health Sciences, Rush University Medical Center, Chicago, IL 60612,Department of Center for Compulsive Behavior and Addiction, Rush University Medical Center, Chicago, IL 60612
| | - Leo P. Kelly
- Department of Pharmacology, Rush University Medical Center, Chicago, IL 60612
| | - Sharanya M. Kousik
- Department of Pharmacology, Rush University Medical Center, Chicago, IL 60612,Department of Center for Compulsive Behavior and Addiction, Rush University Medical Center, Chicago, IL 60612
| | - Steven M. Graves
- Department of Pharmacology, Rush University Medical Center, Chicago, IL 60612,Department of Center for Compulsive Behavior and Addiction, Rush University Medical Center, Chicago, IL 60612
| | - Bryan K. Yamamoto
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN 46202
| | - T. Celeste Napier
- Department of Pharmacology, Rush University Medical Center, Chicago, IL 60612,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612,Department of Center for Compulsive Behavior and Addiction, Rush University Medical Center, Chicago, IL 60612
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15
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Walker IM, Fullard ME, Morley JF, Duda JE. Olfaction as an early marker of Parkinson's disease and Alzheimer's disease. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:317-329. [PMID: 34266602 DOI: 10.1016/b978-0-12-819973-2.00030-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Olfactory impairment is a common and early sign of Parkinson's disease (PD) and Alzheimer's disease (AD), the two most prevalent neurodegenerative conditions in the elderly. This phenomenon corresponds to pathologic processes emerging in the olfactory system prior to the onset of typical clinical manifestations. Clinically available tests can establish hyposmia through odor identification assessment, discrimination, and odor detection threshold. There are significant efforts to develop preventative or disease-modifying therapies that slow down or halt the progression of PD and AD. Due to the convenience and low cost of its assessment, olfactory impairment could be used in these studies as a screening instrument. In the clinical setting, loss of smell may also help to differentiate PD and AD from alternative causes of Parkinsonism and cognitive impairment, respectively. Here, we discuss the pathophysiology of olfactory dysfunction in PD and AD and how it can be assessed in the clinical setting to aid in the early and differential diagnosis of these disorders.
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Affiliation(s)
- Ian M Walker
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz, VA Medical Center, Philadelphia, PA, United States; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michelle E Fullard
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - James F Morley
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz, VA Medical Center, Philadelphia, PA, United States; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - John E Duda
- Parkinson's Disease Research, Education and Clinical Center, Michael J. Crescenz, VA Medical Center, Philadelphia, PA, United States; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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16
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Sasaki S. High Prevalence of Early Parkinson's Disease in Patients With Subtle Parkinsonian Signs. Front Neurol 2021; 12:656679. [PMID: 34305780 PMCID: PMC8299703 DOI: 10.3389/fneur.2021.656679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/02/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Little is known about how frequently patients with a Unified Parkinson Disease Rating Scale part III (UPDRS-III) score of 3 or 4, including postural and action tremor, could be classified into early Parkinson's disease (PD). Objective: To examine the prevalence of early PD in patients with subtle parkinsonian signs (rest tremor, postural tremor, and rigidity) without bradykinesia, having a UPDRS-III score of 3 or 4. Methods: Parkinsonism was assessed using UPDRS-III based on both the United Kingdom PD Society Brain Bank criteria and the Movement Disorder Society PD criteria. Ninety patients with a UPDRS-III score of 3 or 4, including postural tremor, were evaluated by 123I-FP-CIT SPECT (DaTscan), brain MRI, the Mini-Mental State Examination, and smell test. Some patients were additionally examined by 123I-metaiodobenzylguanidine myocardial scintigraphy or 123I-N-isopropyl-p-iodoamphetamine SPECT. Results: Seventy-five [mean age (standard deviation): 76.9 (8.1)] out of 90 patients (83.3%) showed abnormal findings on DaTscan imaging: 57 out of 75 (76.0%) showed a reduced specific binding ratio (SBR) accompanied by an egg shape pattern (n = 37, 49.3%) or a mixed type pattern (n = 14, 18.7%), both reduced SBR and increased asymmetry index (AI) with a normal shape (n = 4, 5.3%), and reduced SBR only (n = 2, 2.7%); 18 (24.0%) showed an egg shape pattern or a mixed type pattern without reduced SBR. In other words, 69 out of 75 patients (92.0%) showed either an egg shape or a mixed type pattern with or without reduced SBR. All patients were free of dementia, and their olfactory function was significantly impaired compared with controls (n = 141) on the odor-stick identification test for Japanese (p < 0.0001). Conclusions: The prevalence of patients with subtle parkinsonian signs having a UPDRS-III score of 3 or 4, including postural tremor, is unexpectedly high in daily clinical practice, and most of these patients could be categorized into mild early-stage PD.
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Affiliation(s)
- Shoichi Sasaki
- Department of Neurology, Agano City Hospital, Niigata, Japan.,Department of Neurology, Toyosaka Hospital, Niigata, Japan
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17
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Dommershuijsen LJ, Boon AJW, Ikram MK. Probing the Pre-diagnostic Phase of Parkinson's Disease in Population-Based Studies. Front Neurol 2021; 12:702502. [PMID: 34276552 PMCID: PMC8284316 DOI: 10.3389/fneur.2021.702502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Parkinson's disease covers a wide spectrum of symptoms, ranging from early non-motor symptoms to the characteristic bradykinesia, tremor and rigidity. Although differences in the symptomatology of Parkinson's disease are increasingly recognized, there is still a lack of insight into the heterogeneity of the pre-diagnostic phase of Parkinson's disease. In this perspective, we highlight three aspects regarding the role of population-based studies in providing new insights into the heterogeneity of pre-diagnostic Parkinson's disease. First we describe several specific advantages of population-based cohort studies, including the design which overcomes some common biases, the broad data collection and the high external validity. Second, we draw a parallel with the field of Alzheimer's disease to provide future directions to uncover the heterogeneity of pre-diagnostic Parkinson's disease. Finally, we anticipate on the emergence of prevention and disease-modification trials and the potential role of population-based studies herein. In the coming years, bridging gaps between study designs will be essential to make vital advances in elucidating the heterogeneity of pre-diagnostic Parkinson's disease.
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Affiliation(s)
| | - Agnita J. W. Boon
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - M. Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
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18
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Yilmaz R, Suenkel U, Postuma RB, Heinzel S, Berg D. Comparing the Two Prodromal Parkinson's Disease Research Criteria-Lessons for Future Studies. Mov Disord 2021; 36:1731-1732. [PMID: 33929050 DOI: 10.1002/mds.28637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rezzak Yilmaz
- Department of Neurology, University of Ankara School of Medicine, Ankara, Turkey
| | - Ulrike Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | | | - Ronald B Postuma
- Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany
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Kondo K, Kikuta S, Ueha R, Suzukawa K, Yamasoba T. Age-Related Olfactory Dysfunction: Epidemiology, Pathophysiology, and Clinical Management. Front Aging Neurosci 2020; 12:208. [PMID: 32733233 PMCID: PMC7358644 DOI: 10.3389/fnagi.2020.00208] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/12/2020] [Indexed: 12/21/2022] Open
Abstract
Like other sensory systems, olfactory function deteriorates with age. Epidemiological studies have revealed that the incidence of olfactory dysfunction increases at the age of 60 and older and males are more affected than females. Moreover, smoking, heavy alcohol use, sinonasal diseases, and Down’s syndrome are associated with an increased incidence of olfactory dysfunction. Although the pathophysiology of olfactory dysfunction in humans remains largely unknown, studies in laboratory animals have demonstrated that both the peripheral and central olfactory nervous systems are affected by aging. Aged olfactory neuroepithelium in the nasal cavity shows the loss of mature olfactory neurons, replacement of olfactory neuroepithelium by respiratory epithelium, and a decrease in basal cell proliferation both in the normal state and after injury. In the central olfactory pathway, a decrease in the turnover of interneurons in the olfactory bulb (OB) and reduced activity in the olfactory cortex under olfactory stimulation is observed. Recently, the association between olfactory impairment and neurodegenerative diseases, such as Alzheimer’s disease (AD) and Parkinson’s disease (PD), has gained attention. Evidence-based pharmacotherapy to suppress or improve age-related olfactory dysfunction has not yet been established, but preliminary results suggest that olfactory training using odorants may be useful to improve some aspects of age-related olfactory impairment.
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Affiliation(s)
- Kenji Kondo
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shu Kikuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keigo Suzukawa
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Monje MHG, Foffani G, Obeso J, Sánchez-Ferro Á. New Sensor and Wearable Technologies to Aid in the Diagnosis and Treatment Monitoring of Parkinson's Disease. Annu Rev Biomed Eng 2020; 21:111-143. [PMID: 31167102 DOI: 10.1146/annurev-bioeng-062117-121036] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Parkinson's disease (PD) is a degenerative disorder of the brain characterized by the impairment of the nigrostriatal system. This impairment leads to specific motor manifestations (i.e., bradykinesia, tremor, and rigidity) that are assessed through clinical examination, scales, and patient-reported outcomes. New sensor-based and wearable technologies are progressively revolutionizing PD care by objectively measuring these manifestations and improving PD diagnosis and treatment monitoring. However, their use is still limited in clinical practice, perhaps because of the absence of external validation and standards for their continuous use at home. In the near future, these systems will progressively complement traditional tools and revolutionize the way we diagnose and monitor patients with PD.
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Affiliation(s)
- Mariana H G Monje
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938 Móstoles, Madrid, Spain; , , , .,Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - Guglielmo Foffani
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938 Móstoles, Madrid, Spain; , , , .,Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, 45071 Toledo, Spain
| | - José Obeso
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938 Móstoles, Madrid, Spain; , , , .,Centro de Investigación Biomédica en Red, Enfermedades Neurodegenerativas, 28031 Madrid, Spain
| | - Álvaro Sánchez-Ferro
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938 Móstoles, Madrid, Spain; , , , .,Centro de Investigación Biomédica en Red, Enfermedades Neurodegenerativas, 28031 Madrid, Spain.,Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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21
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Joppe K, Nicolas JD, Grünewald TA, Eckermann M, Salditt T, Lingor P. Elemental quantification and analysis of structural abnormalities in neurons from Parkinson's-diseased brains by X-ray fluorescence microscopy and diffraction. BIOMEDICAL OPTICS EXPRESS 2020; 11:3423-3443. [PMID: 33014542 PMCID: PMC7510930 DOI: 10.1364/boe.389408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/07/2020] [Accepted: 03/23/2020] [Indexed: 05/11/2023]
Abstract
In this work we use scanning X-ray microscopy to study the structure and elemental composition of neuromelanin-positive neurons in substantia nigra tissue of Parkinson patients (PD) and controls. A total of 53 neurons were analyzed with X-ray fluorescence (XRF) and diffraction using sub-µm-focused synchrotron radiation. A statistical evaluation identified copper as the most group-discriminating element and indicated that interindividual and intraindividual variations are of great relevance in tissue measurements of diseased patients and prevent from automated group clustering. XRF analyses of two Lewy bodies (LBs) highlight a heterogeneity in elemental distributions in these LBs, whereas an innovative X-ray diffraction-based method approach was used to reveal β-sheet-rich crystalline structures in LBs. Overall, sub-µm-focus X-ray microscopy highlighted the elemental heterogeneity in PD pathology.
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Affiliation(s)
- Karina Joppe
- Department of Neurology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075 Goettingen, Germany
- Center for Biostructural Imaging of Neurodegeneration, University Medical Center Goettingen, Von-Siebold-Straße 3a, 37075 Goettingen, Germany
- These authors contributed equally
| | - Jan-David Nicolas
- Institute for X-Ray Physics, Georg-August-University Goettingen, Friedrich-Hund-Platz 1, 37077 Goettingen, Germany
- These authors contributed equally
| | - Tilman A. Grünewald
- European Synchrotron Radiation Facility, 71 Avenue des Martyrs, 38043 Grenoble, France
- CNRS, Centrale Marseille, Institut Fresnel, Aix-Marseille University, 52 Avenue Escadrille Normandie Niemen, 13013 Marseille, France
| | - Marina Eckermann
- Institute for X-Ray Physics, Georg-August-University Goettingen, Friedrich-Hund-Platz 1, 37077 Goettingen, Germany
| | - Tim Salditt
- Institute for X-Ray Physics, Georg-August-University Goettingen, Friedrich-Hund-Platz 1, 37077 Goettingen, Germany
- Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Goettingen, Germany
| | - Paul Lingor
- Department of Neurology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075 Goettingen, Germany
- Center for Biostructural Imaging of Neurodegeneration, University Medical Center Goettingen, Von-Siebold-Straße 3a, 37075 Goettingen, Germany
- Department of Neurology, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
- DFG Cluster of Excellence Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
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Trifonova OP, Maslov DL, Balashova EE, Urazgildeeva GR, Abaimov DA, Fedotova EY, Poleschuk VV, Illarioshkin SN, Lokhov PG. Parkinson's Disease: Available Clinical and Promising Omics Tests for Diagnostics, Disease Risk Assessment, and Pharmacotherapy Personalization. Diagnostics (Basel) 2020; 10:E339. [PMID: 32466249 PMCID: PMC7277996 DOI: 10.3390/diagnostics10050339] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022] Open
Abstract
Parkinson's disease is the second most frequent neurodegenerative disease, representing a significant medical and socio-economic problem. Modern medicine still has no answer to the question of why Parkinson's disease develops and whether it is possible to develop an effective system of prevention. Therefore, active work is currently underway to find ways to assess the risks of the disease, as well as a means to extend the life of patients and improve its quality. Modern studies aim to create a method of assessing the risk of occurrence of Parkinson's disease (PD), to search for the specific ways of correction of biochemical disorders occurring in the prodromal stage of Parkinson's disease, and to personalize approaches to antiparkinsonian pharmacotherapy. In this review, we summarized all available clinically approved tests and techniques for PD diagnostics. Then, we reviewed major improvements and recent advancements in genomics, transcriptomics, and proteomics studies and application of metabolomics in PD research, and discussed the major metabolomics findings for diagnostics and therapy of the disease.
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Affiliation(s)
- Oxana P. Trifonova
- Laboratory of mass spectrometry-based metabolomics diagnostics, Institute of Biomedical Chemistry, 10 building 8, Pogodinskaya street, 119121 Moscow, Russia; (D.L.M.); (E.E.B.); (P.G.L.)
| | - Dmitri L. Maslov
- Laboratory of mass spectrometry-based metabolomics diagnostics, Institute of Biomedical Chemistry, 10 building 8, Pogodinskaya street, 119121 Moscow, Russia; (D.L.M.); (E.E.B.); (P.G.L.)
| | - Elena E. Balashova
- Laboratory of mass spectrometry-based metabolomics diagnostics, Institute of Biomedical Chemistry, 10 building 8, Pogodinskaya street, 119121 Moscow, Russia; (D.L.M.); (E.E.B.); (P.G.L.)
| | - Guzel R. Urazgildeeva
- 5th Neurological Department (Department of Neurogenetics), Research Centre of Neurology, Volokolamskoe shosse, 80, 125367 Moscow, Russia; (G.R.U.); (D.A.A.); (E.Y.F.); (V.V.P.); (S.N.I.)
| | - Denis A. Abaimov
- 5th Neurological Department (Department of Neurogenetics), Research Centre of Neurology, Volokolamskoe shosse, 80, 125367 Moscow, Russia; (G.R.U.); (D.A.A.); (E.Y.F.); (V.V.P.); (S.N.I.)
| | - Ekaterina Yu. Fedotova
- 5th Neurological Department (Department of Neurogenetics), Research Centre of Neurology, Volokolamskoe shosse, 80, 125367 Moscow, Russia; (G.R.U.); (D.A.A.); (E.Y.F.); (V.V.P.); (S.N.I.)
| | - Vsevolod V. Poleschuk
- 5th Neurological Department (Department of Neurogenetics), Research Centre of Neurology, Volokolamskoe shosse, 80, 125367 Moscow, Russia; (G.R.U.); (D.A.A.); (E.Y.F.); (V.V.P.); (S.N.I.)
| | - Sergey N. Illarioshkin
- 5th Neurological Department (Department of Neurogenetics), Research Centre of Neurology, Volokolamskoe shosse, 80, 125367 Moscow, Russia; (G.R.U.); (D.A.A.); (E.Y.F.); (V.V.P.); (S.N.I.)
| | - Petr G. Lokhov
- Laboratory of mass spectrometry-based metabolomics diagnostics, Institute of Biomedical Chemistry, 10 building 8, Pogodinskaya street, 119121 Moscow, Russia; (D.L.M.); (E.E.B.); (P.G.L.)
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Leger C, Herbert M, DeSouza JFX. Non-motor Clinical and Biomarker Predictors Enable High Cross-Validated Accuracy Detection of Early PD but Lesser Cross-Validated Accuracy Detection of Scans Without Evidence of Dopaminergic Deficit. Front Neurol 2020; 11:364. [PMID: 32477243 PMCID: PMC7232850 DOI: 10.3389/fneur.2020.00364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Early stage (preclinical) detection of Parkinson's disease (PD) remains challenged yet is crucial to both differentiate it from other disorders and facilitate timely administration of neuroprotective treatment as it becomes available. Objective: In a cross-validation paradigm, this work focused on two binary predictive probability analyses: classification of early PD vs. controls and classification of early PD vs. SWEDD (scans without evidence of dopamine deficit). It was hypothesized that five distinct model types using combined non-motor and biomarker features would distinguish early PD from controls with > 80% cross-validated (CV) accuracy, but that the diverse nature of the SWEDD category would reduce early PD vs. SWEDD CV classification accuracy and alter model-based feature selection. Methods: Cross-sectional, baseline data was acquired from the Parkinson's Progressive Markers Initiative (PPMI). Logistic regression, general additive (GAM), decision tree, random forest and XGBoost models were fitted using non-motor clinical and biomarker features. Randomized train and test data partitions were created. Model classification CV performance was compared using the area under the curve (AUC), sensitivity, specificity and the Kappa statistic. Results: All five models achieved >0.80 AUC CV accuracy to distinguish early PD from controls. The GAM (CV AUC 0.928, sensitivity 0.898, specificity 0.897) and XGBoost (CV AUC 0.923, sensitivity 0.875, specificity 0.897) models were the top classifiers. Performance across all models was consistently lower in the early PD/SWEDD analyses, where the highest performing models were XGBoost (CV AUC 0.863, sensitivity 0.905, specificity 0.748) and random forest (CV AUC 0.822, sensitivity 0.809, specificity 0.721). XGBoost detection of non-PD SWEDD matched 1-2 years curated diagnoses in 81.25% (13/16) cases. In both early PD/control and early PD/SWEDD analyses, and across all models, hyposmia was the single most important feature to classification; rapid eye movement behavior disorder (questionnaire) was the next most commonly high ranked feature. Alpha-synuclein was a feature of import to early PD/control but not early PD/SWEDD classification and the Epworth Sleepiness scale was antithetically important to the latter but not former. Interpretation: Non-motor clinical and biomarker variables enable high CV discrimination of early PD vs. controls but are less effective discriminating early PD from SWEDD.
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Affiliation(s)
- Charles Leger
- Department of Psychology, York University, Toronto, ON, Canada
- Neuroscience Diploma, York University, Toronto, ON, Canada
| | - Monique Herbert
- Department of Psychology, York University, Toronto, ON, Canada
| | - Joseph F. X. DeSouza
- Department of Psychology, York University, Toronto, ON, Canada
- Neuroscience Diploma, York University, Toronto, ON, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
- Department of Biology, York University, Toronto, ON, Canada
- Canadian Action and Perception Network (CAPnet), Vision: Science to Applications (VISTA), York University, Toronto, ON, Canada
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24
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Liu R, Umbach DM, Tröster AI, Huang X, Chen H. Non-motor symptoms and striatal dopamine transporter binding in early Parkinson's disease. Parkinsonism Relat Disord 2020; 72:23-30. [PMID: 32092703 DOI: 10.1016/j.parkreldis.2020.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/13/2020] [Accepted: 02/03/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Non-motor symptoms (NMS) are common in Parkinson's disease (PD), but their relationships to nigrostriatal degeneration remain largely unexplored. METHODS We evaluated 18 NMS scores covering 5 major domains in relation to concurrent and future dopamine transporter (DAT) imaging in 344 PD patients from the Parkinson's Progression and Markers Initiative (PPMI). We standardized NMS assessments into z-scores for side-by-side comparisons. Patients underwent sequential DaTSCAN imaging at enrollment and at months 12, 24, and 48. Specific binding ratios (SBR) were calculated using the occipital lobe reference region. We evaluated the association of striatal DAT binding at the four time points with each baseline NMS using mixed-effects regression models. RESULTS Multiple baseline NMS were significantly associated with DAT binding at baseline and at follow-up scans. REM sleep behavior disorder (RBD) symptoms showed the strongest association - mean striatal SBR declined with increasing RBD symptom z-score (average of time-point-specific slopes per unit change in z-score: βAVG = -0.083, SE = 0.017; p < 0.0001). In addition, striatal DAT binding was linearly associated with increasing baseline z-scores: positively for the memory (βAVG=0.055, SE = 0.022; p = 0.01) and visuospatial (βAVG=0.044, SE = 0.020; p = 0.03) cognitive domains, and negatively for total anxiety (βAVG= -0.059, SE = 0.018; p = 0.001). Striatal DAT binding showed curvilinear associations with odor identification, verbal discrimination recognition, and autonomic dysfunction z-scores (p = 0.001, p = 0.0009, and p = 0.0002, respectively). Other NMS were not associated with DAT binding. CONCLUSIONS Multiple NMS, RBD symptoms in particular, are associated with nigrostriatal dopaminergic changes in early PD.
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Affiliation(s)
- Rui Liu
- Southern Connecticut State University, New Haven, CT, USA.
| | - David M Umbach
- Biostatistics Branch of the National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Alexander I Tröster
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Xuemei Huang
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
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25
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Sakakibara S, Hashimoto R, Katayama T, Kenjyo M, Yokokawa Y, Saito Y, Hirakawa A, Ito M, Nakamura T, Hara K, Hashizume A, Aiba I, Inukai A, Katsuno M. Longitudinal Change of DAT SPECT in Parkinson's Disease and Multiple System Atrophy. JOURNAL OF PARKINSONS DISEASE 2019; 10:123-130. [PMID: 31707374 DOI: 10.3233/jpd-191710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Both Parkinson's disease (PD) and multiple system atrophy (MSA) are neurodegenerative disorder affecting striatonigral system. Although various lines of evidence demonstrate that dopaminergic neuron degeneration emerges before the onset of motor symptoms in PD, preclinical/prodromal progression of neurodegeneration is far less understood in MSA. OBJECTIVE The aim of this study was to clarify the difference in the progression of dopaminergic degeneration in MSA and PD using dopamine transporter single-photon emission computed tomography (DAT SPECT). METHODS We analyzed longitudinal data of the specific binding ratio (SBR), a measure of striatal radiotracer uptake, in DAT SPECT from 7 patients with MSA-C, 5 patients with MSA-P, and 18 patients with PD. We performed 2.7±0.7 scans with an interval of 9.85±6.00 months for MSA and 2 scans with an interval of 2.16±0.16 years for PD. RESULTS The rate of SBR decline was faster in both subtypes of MSA compared with PD, but the value was similar between MSA-P and MSA-C. The estimated SBR at the onset of initial motor symptoms was lower in PD and MSA-P than in MSA-C, especially in the predominantly affected side. SBR of the predominantly affected side starts to decrease before the onset of motor symptoms in PD and MSA-P, whereas the initiation of SBR decline is around the onset in MSA-C individuals. The decline of SBR in the less affected side was not clearly shown before the onset in MSA-P or MSA-C. CONCLUSIONS Our results suggest that the SBR in DAT SPECT analysis is an important pathophysiological marker reflecting the disease- and subtype-specific progression of dopaminergic degeneration in MSA and PD.
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Affiliation(s)
- Satoko Sakakibara
- Department of Neurology, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Rina Hashimoto
- Department of Neurology, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
| | - Taiji Katayama
- Department of Neurology, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
| | - Masakuni Kenjyo
- Department of Neurology, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
| | - Yuki Yokokawa
- Department of Neurology, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
| | - Yufuko Saito
- Department of Neurology, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
| | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mizuki Ito
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiko Nakamura
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kazuhiro Hara
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Hashizume
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ikuko Aiba
- Department of Neurology, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
| | - Akira Inukai
- Department of Neurology, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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26
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Sixel-Döring F. Prognostic Counseling for Patients With Idiopathic/Isolated Rapid Eye Movement Sleep Behavior Disorder: Should We Tell Them What's Coming? No. Mov Disord Clin Pract 2019; 6:669-671. [PMID: 31745476 DOI: 10.1002/mdc3.12813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/13/2019] [Accepted: 06/29/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Friederike Sixel-Döring
- Paracelsus-Elena-Klinik, Kassel & Department of Neurology Philipps-University Marburg Germany
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27
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Joseph T, Auger SD, Peress L, Rack D, Cuzick J, Giovannoni G, Lees A, Schrag AE, Noyce AJ. Screening performance of abbreviated versions of the UPSIT smell test. J Neurol 2019; 266:1897-1906. [PMID: 31053960 PMCID: PMC6647236 DOI: 10.1007/s00415-019-09340-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/17/2019] [Accepted: 04/23/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hyposmia can develop with age and in neurodegenerative conditions, including Parkinson's disease (PD). The University of Pennsylvania Smell Identification Test (UPSIT) is a 40-item smell test widely used for assessing hyposmia. However, in a number of situations, such as identifying hyposmic individuals in large populations, shorter tests are preferable. METHODS We assessed the ability of shorter UPSIT subsets to detect hyposmia in 891 healthy participants from the PREDICT-PD study. Shorter subsets included Versions A and B of the 4-item Pocket Smell Test (PST) and 12-item Brief Smell Identification Test (BSIT). Using a data-driven approach, we evaluated screening performances of 23,231,378 combinations of 1-7 smell items from the full UPSIT to derive "winning" subsets, and validated findings separately in another 191 healthy individuals. We then compared discriminatory UPSIT smells between PREDICT-PD participants and 40 PD patients, and assessed the performance of "winning" subsets containing discriminatory smells in PD patients. RESULTS PST Versions A and B achieved sensitivity/specificity of 76.8%/64.9% and 86.6%/45.9%, respectively, while BSIT Versions A and B achieved 83.1%/79.5% and 96.5%/51.8%. From the data-driven analysis, 2 "winning" 7-item subsets surpassed the screening performance of 12-item BSITs (validation sensitivity/specificity of 88.2%/85.4% and 100%/53.5%), while a "winning" 4-item subset had higher sensitivity than PST-A, -B, and even BSIT-A (validation sensitivity 91.2%). Interestingly, several discriminatory smells featured within "winning" subsets, and demonstrated high-screening performances for identifying hyposmic PD patients. CONCLUSION Using abbreviated smell tests could provide a cost-effective means of large-scale hyposmia screening, allowing more targeted UPSIT administration in general and PD-related settings.
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Affiliation(s)
| | - Stephen D Auger
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Luisa Peress
- Barts and The London School of Medicine and Dentistry, London, UK
| | - Daniel Rack
- Barts and The London School of Medicine and Dentistry, London, UK
| | - Jack Cuzick
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Gavin Giovannoni
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- Blizard Institute, Barts and the London Queen Mary University of London, London, UK
| | - Andrew Lees
- Reta Lila Weston Institute, Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, London, UK
| | - Anette E Schrag
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, London, UK
| | - Alastair J Noyce
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK.
- Reta Lila Weston Institute, Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, London, UK.
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28
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Sobhani S, Rahmani F, Aarabi MH, Sadr AV. Exploring white matter microstructure and olfaction dysfunction in early parkinson disease: diffusion MRI reveals new insight. Brain Imaging Behav 2019; 13:210-219. [PMID: 29134611 DOI: 10.1007/s11682-017-9781-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Olfaction dysfunction is considered as a robust marker of prodromal Parkinson disease (PD). Measurement of olfaction function as a screening test is unsatisfactory due to long lead time interval and low specificity for detection of PD. Use of imaging markers might yield more accurate predictive values and provide bases for combined use of imaging and clinical markers for early PD. Diffusion MRI connectometry was conducted on 85 de novo PD patients in and 36 healthy controls to find: first, white matter tracts with significant difference in quantitative anisotropy between PD groups with various degrees of olfaction dysfunction and second, second fibers with correlation with University of Pennsylvania Smell Identification Test (UPSIT) score in each group using a multiple regression analysis considering age, sex, GDS and MoCA score. Local connectomes were determined in seven of all the possible comparisons, correcting for false discovery rate (FDR). PD patients with anosmia and normal olfaction had the highest number of fibers with decreased connectivity in left inferior longitudinal fasciculus, bilateral fornix, bilateral middle cerebellar peduncle (MCP), bilateral cingulum, bilateral corticospinal tract (CST) and body, genu and splenium of corpus callosum (CC) (FDR = 0.0013). In multiple regression analysis, connectivity in the body, genu and splenium of CC and bilateral fornix had significant negative correlation (FDR between 0.019 and 0.083), and bilateral cingulum and MCP had significant positive correlation (FDR between 0.022 and 0.092) with UPSIT score. White matter connectivity in healthy controls could not be predicted by UPSIT score using the same model. The results of this study provide compelling evidence that microstructural degenerative changes in these areas underlie the clinical phenotype of prodromal olfaction dysfunction in PD and that diffusion parameters of these areas might be able to serve as signature markers for early detection of PD. This is the first report that confirms a discriminative role for UPSIT score in identifying PD specific changes in white matter microstructure. Our results open a window to identify microstructural signatures of prodromal PD in white matter.
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Affiliation(s)
- Soheila Sobhani
- Basir Eye Health Research Center, Tehran, Iran
- Neuroimaging Network (NIN), Universal Scientific Education and Research Network (USERN), Children's Medical Center Hospital, Tehran, 14194, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Rahmani
- Neuroimaging Network (NIN), Universal Scientific Education and Research Network (USERN), Children's Medical Center Hospital, Tehran, 14194, Iran.
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Hadi Aarabi
- Basir Eye Health Research Center, Tehran, Iran
- Neuroimaging Network (NIN), Universal Scientific Education and Research Network (USERN), Children's Medical Center Hospital, Tehran, 14194, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Vafaei Sadr
- Department of Physics, Shahid Beheshti University, G.C., Evin, Tehran, Iran
- Département de Physique Théorique and Center for Astroparticle Physics, Université de Genève, Geneva, Switzerland
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Marek K, Chowdhury S, Siderowf A, Lasch S, Coffey CS, Caspell‐Garcia C, Simuni T, Jennings D, Tanner CM, Trojanowski JQ, Shaw LM, Seibyl J, Schuff N, Singleton A, Kieburtz K, Toga AW, Mollenhauer B, Galasko D, Chahine LM, Weintraub D, Foroud T, Tosun‐Turgut D, Poston K, Arnedo V, Frasier M, Sherer T. The Parkinson's progression markers initiative (PPMI) - establishing a PD biomarker cohort. Ann Clin Transl Neurol 2018; 5:1460-1477. [PMID: 30564614 PMCID: PMC6292383 DOI: 10.1002/acn3.644] [Citation(s) in RCA: 257] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The Parkinson's Progression Markers Initiative (PPMI) is an observational, international study designed to establish biomarker-defined cohorts and identify clinical, imaging, genetic, and biospecimen Parkinson's disease (PD) progression markers to accelerate disease-modifying therapeutic trials. METHODS A total of 423 untreated PD, 196 Healthy Control (HC) and 64 SWEDD (scans without evidence of dopaminergic deficit) subjects were enrolled at 24 sites. To enroll PD subjects as early as possible following diagnosis, subjects were eligible with only asymmetric bradykinesia or tremor plus a dopamine transporter (DAT) binding deficit on SPECT imaging. Acquisition of data was standardized as detailed at www.ppmi-info.org. RESULTS Approximately 9% of enrolled subjects had a single PD sign at baseline. DAT imaging excluded 16% of potential PD subjects with SWEDD. The total MDS-UPDRS for PD was 32.4 compared to 4.6 for HC and 28.2 for SWEDD. On average, PD subjects demonstrated 45% and 68% reduction in mean striatal and contralateral putamen Specific Binding Ratios (SBR), respectively. Cerebrospinal fluid (CSF) was acquired from >97% of all subjects. CSF (PD/HC/SWEDD pg/mL) α-synuclein (1845/2204/2141) was reduced in PD vs HC or SWEDD (P < 0.03). Similarly, t-tau (45/53) and p-tau (16/18) were reduced in PD versus HC (P < 0.01). INTERPRETATION PPMI has detailed the biomarker signature for an early PD cohort defined by clinical features and imaging biomarkers. This strategy provides the framework to establish biomarker cohorts and to define longitudinal progression biomarkers to support future PD treatment trials.
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Affiliation(s)
- Kenneth Marek
- Institute for Neurodegenerative DisordersNew HavenConnecticut
| | - Sohini Chowdhury
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew York
| | | | - Shirley Lasch
- Institute for Neurodegenerative DisordersNew HavenConnecticut
| | | | | | | | | | | | | | | | - John Seibyl
- Institute for Neurodegenerative DisordersNew HavenConnecticut
| | | | | | - Karl Kieburtz
- Clinical Trials Coordination CenterUniversity of RochesterRochesterNew York
| | | | | | | | | | | | | | | | | | - Vanessa Arnedo
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew York
| | - Mark Frasier
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew York
| | - Todd Sherer
- The Michael J. Fox Foundation for Parkinson's ResearchNew YorkNew York
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30
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Finberg JPM, Schwartz M, Jeries R, Badarny S, Nakhleh MK, Abu Daoud E, Ayubkhanov Y, Aboud-Hawa M, Broza YY, Haick H. Sensor Array for Detection of Early Stage Parkinson's Disease before Medication. ACS Chem Neurosci 2018; 9:2548-2553. [PMID: 29989795 DOI: 10.1021/acschemneuro.8b00245] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Early diagnosis of Parkinson's disease (PD) is important because it affects the choice of therapy and is subject to a relatively high degree of error. In addition, early detection of PD can potentially enable the start of neuroprotective therapy before extensive loss of dopaminergic neurons of the substantia nigra occurs. However, until now, studies for early detection of PD using volatile biomarkers sampled only treated and medicated patients. Therefore, there is a great need to evaluate untreated patients for establishing a real world screening and diagnostic technology. Here we describe for the first time a clinical trial to distinguish between de novo PD and control subjects using an electronic system for detection of volatile molecules in exhaled breath (sensor array). We further determine for the first time the association to other common tests for PD diagnostics as smell, ultrasound, and nonmotor symptoms. The test group consisted of 29 PD patients after initial diagnosis by an experienced neurologist, compared with 19 control subjects of similar age. The sensitivity, specificity, and accuracy values of the sensor array to detect PD from controls were 79%, 84%, and 81% respectively, in comparison with midbrain ultrasonography (93%, 90%, 92%) and smell detection (62%, 89%, 73%). The results confirm previous data showing the potential of sensor arrays to detect PD.
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Affiliation(s)
- John P. M. Finberg
- Neuroscience Department, Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Miguel Schwartz
- Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Raneen Jeries
- Department of Chemical Engineering, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Samih Badarny
- Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Morad K. Nakhleh
- Department of Chemical Engineering, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Enas Abu Daoud
- Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Yelena Ayubkhanov
- Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Manal Aboud-Hawa
- Department of Chemical Engineering, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Yoav Y Broza
- Department of Chemical Engineering, Technion - Israel Institute of Technology, Haifa 3200003, Israel
| | - Hossam Haick
- Department of Chemical Engineering, Technion - Israel Institute of Technology, Haifa 3200003, Israel
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31
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Sanjari Moghaddam H, Dolatshahi M, Salardini E, Aarabi MH. Association of olfaction dysfunction with brain microstructure in prodromal Parkinson disease. Neurol Sci 2018; 40:283-291. [DOI: 10.1007/s10072-018-3629-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/26/2018] [Indexed: 01/07/2023]
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32
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Abstract
Efforts to develop neuroprotective therapy for Parkinson disease (PD) are focusing on the early stages of disease, which offer the best opportunity to intervene. Early PD can be divided into preclinical, prodromal and clinical stages; in this Review, we focus on the prodromal stage and markers that can be used to identify prodromal PD. We consider the necessary properties of a marker, before providing an overview of the proven and potential markers of prodromal PD, including clinical nonmotor markers, clinical motor markers, neuroimaging markers and tissue biomarkers. Markers for which the ability to predict conversion to PD is supported by the strongest evidence include olfactory loss, REM sleep behaviour disorder and constipation. Markers with the highest diagnostic strength include REM sleep behaviour disorder, dopaminergic imaging and subtle motor parkinsonism. The lead time - the period between the appearance of a marker and conversion to PD - is highly variable between markers, ranging from 5 years for impaired motor performance to >20 years for autonomic symptoms. The cost of screening for these markers also varies dramatically: some require just questionnaires, whereas others require sophisticated scanning techniques. Finally, we summarize how prodromal and risk markers can be combined to estimate the probability that an individual has prodromal PD, with a focus on the International Parkinson Disease and Movement Disorders Society (MDS) Prodromal Parkinson Criteria.
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Affiliation(s)
- Ronald B Postuma
- Department of Neurology, L7-305 Montreal General Hospital, 1650 Cedar Avenue, Montreal H3G1A4, Canada
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University of Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.,Department of neurodegeneration, Hertie Institute of Clinical Brain Research, Hoppe, Seyler-Straße 3, 72076 Tübingen, Germany
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Karimi-Moghadam A, Charsouei S, Bell B, Jabalameli MR. Parkinson Disease from Mendelian Forms to Genetic Susceptibility: New Molecular Insights into the Neurodegeneration Process. Cell Mol Neurobiol 2018; 38:1153-1178. [PMID: 29700661 PMCID: PMC6061130 DOI: 10.1007/s10571-018-0587-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/20/2018] [Indexed: 12/13/2022]
Abstract
Parkinson disease (PD) is known as a common progressive neurodegenerative disease which is clinically diagnosed by the manifestation of numerous motor and nonmotor symptoms. PD is a genetically heterogeneous disorder with both familial and sporadic forms. To date, researches in the field of Parkinsonism have identified 23 genes or loci linked to rare monogenic familial forms of PD with Mendelian inheritance. Biochemical studies revealed that the products of these genes usually play key roles in the proper protein and mitochondrial quality control processes, as well as synaptic transmission and vesicular recycling pathways within neurons. Despite this, large number of patients affected with PD typically tends to show sporadic forms of disease with lack of a clear family history. Recent genome-wide association studies (GWAS) meta-analyses on the large sporadic PD case-control samples from European populations have identified over 12 genetic risk factors. However, the genetic etiology that underlies pathogenesis of PD is also discussed, since it remains unidentified in 40% of all PD-affected cases. Nowadays, with the emergence of new genetic techniques, international PD genomics consortiums and public online resources such as PDGene, there are many hopes that future large-scale genetics projects provide further insights into the genetic etiology of PD and improve diagnostic accuracy and therapeutic clinical trial designs.
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Affiliation(s)
- Amin Karimi-Moghadam
- Division of Genetics, Department of Biology, Faculty of Science, University of Isfahan, Isfahan, Iran
| | - Saeid Charsouei
- Department of Neurology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Benjamin Bell
- Human Genetics & Genomic Medicine, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Mohammad Reza Jabalameli
- Division of Genetics, Department of Biology, Faculty of Science, University of Isfahan, Isfahan, Iran.
- Human Genetics & Genomic Medicine, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK.
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Benvenutti R, Marcon M, Reis CG, Nery LR, Miguel C, Herrmann AP, Vianna MRM, Piato A. N-acetylcysteine protects against motor, optomotor and morphological deficits induced by 6-OHDA in zebrafish larvae. PeerJ 2018; 6:e4957. [PMID: 29868300 PMCID: PMC5985760 DOI: 10.7717/peerj.4957] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/22/2018] [Indexed: 12/13/2022] Open
Abstract
Background Parkinson's disease (PD) is the second most common neurodegenerative disorder. In addition to its highly debilitating motor symptoms, non-motor symptoms may precede their motor counterparts by many years, which may characterize a prodromal phase of PD. A potential pharmacological strategy is to introduce neuroprotective agents at an earlier stage in order to prevent further neuronal death. N-acetylcysteine (NAC) has been used against paracetamol overdose hepatotoxicity by restoring hepatic concentrations of glutathione (GSH), and as a mucolytic in chronic obstructive pulmonary disease by reducing disulfide bonds in mucoproteins. It has been shown to be safe for humans at high doses. More recently, several studies have evidenced that NAC has a multifaceted mechanism of action, presenting indirect antioxidant effect by acting as a GSH precursor, besides its anti-inflammatory and neurotrophic effects. Moreover, NAC modulates glutamate release through activation of the cystine-glutamate antiporter in extra-synaptic astrocytes. Its therapeutic benefits have been demonstrated in clinical trials for several neuropsychiatric conditions but has not been tested in PD models yet. Methods In this study, we evaluated the potential of NAC to prevent the damage induced by 6-hydroxydopamine (6-OHDA) on motor, optomotor and morphological parameters in a PD model in larval zebrafish. Results NAC was able to prevent the motor deficits (total distance, mean speed, maximum acceleration, absolute turn angle and immobility time), optomotor response impairment and morphological alterations (total length and head length) caused by exposure to 6-OHDA, which reinforce and broaden the relevance of its neuroprotective effects. Discussion NAC acts in different targets relevant to PD pathophysiology. Further studies and clinical trials are needed to assess this agent as a candidate for prevention and adjunctive treatment of PD.
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Affiliation(s)
- Radharani Benvenutti
- Programa de Pós-graduação em Neurociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Matheus Marcon
- Programa de Pós-graduação em Neurociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos G Reis
- Programa de Pós-graduação em Neurociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura R Nery
- Programa de Pós-graduação em Biologia Celular e Molecular, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Camila Miguel
- Programa de Pós-graduação em Zoologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ana P Herrmann
- Programa de Pós-graduação em Farmacologia e Terapêutica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Monica R M Vianna
- Programa de Pós-graduação em Biologia Celular e Molecular, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Programa de Pós-graduação em Zoologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Angelo Piato
- Programa de Pós-graduação em Neurociências, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Programa de Pós-graduação em Farmacologia e Terapêutica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Mahlknecht P, Gasperi A, Djamshidian A, Kiechl S, Stockner H, Willeit P, Willeit J, Rungger G, Poewe W, Seppi K. Performance of the Movement Disorders Society criteria for prodromal Parkinson's disease: A population-based 10-year study. Mov Disord 2018; 33:405-413. [PMID: 29436728 DOI: 10.1002/mds.27281] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/09/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE We aimed to identify prodromal Parkinson's disease (PD) and its predictive accuracy for incident PD in an unselected elderly population and to estimate the relevance of this approach for future neuroprotection trials. METHODS We applied the recently published Movement Disorders Society (MDS) research criteria for prodromal PD to participants of the prospective population-based Bruneck Study of the 2005 assessment (n = 574, ages 55-94 years). Cases of incident PD were identified at 3-year, 5-year, and 10-year follow-up visits. We calculated predictive accuracies of baseline prodromal PD status for incident cases, and, based on them, estimated sample sizes for neuroprotection trials with conversion to PD as the primary outcome. RESULTS Baseline status of probable prodromal PD (n = 12) had a specificity in predicting incident PD of 98.8% (95% confidence interval, 97.3%-99.5%), a sensitivity of 66.7% (29.6%-90.8%), and a positive predictive value of 40.0% (16.7%-68.8%) over 3 years. Specificity remained stable with increasing follow-up time, sensitivity decreased to 54.6% (28.0%-78.8%) over 5 years and to 35.0% (18.0%-56.8%) over 10 years, whereas positive predictive value rose to 60.0% (31.2%-83.3%) and 77.8% (44.3%-94.7%), respectively. Sample size estimates at 80% power in an intention-to-treat approach ranged from 108 to 540 patients with probable prodromal PD depending on trial duration (3-5 years) and effect size of the agent (30%-50%). CONCLUSIONS Our findings show that the MDS criteria for prodromal PD yield moderate to high predictive power for incident PD in a community-based setting and may thus be helpful to define target populations of future neuroprotection trials. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Arno Gasperi
- Department of Neurology, Hospital of Bruneck, Bruneck, Italy
| | - Atbin Djamshidian
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Heike Stockner
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Peter Willeit
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Johann Willeit
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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Nair AT, Ramachandran V, Joghee NM, Antony S, Ramalingam G. Gut Microbiota Dysfunction as Reliable Non-invasive Early Diagnostic Biomarkers in the Pathophysiology of Parkinson's Disease: A Critical Review. J Neurogastroenterol Motil 2018; 24:30-42. [PMID: 29291606 PMCID: PMC5753901 DOI: 10.5056/jnm17105] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/08/2017] [Accepted: 11/20/2017] [Indexed: 12/13/2022] Open
Abstract
Recent investigations suggest that gut microbiota affects the brain activity through the microbiota-gut-brain axis under both physiological and pathological disease conditions like Parkinson's disease. Further dopamine synthesis in the brain is induced by dopamine producing enzymes that are controlled by gut microbiota via the microbiota-gut-brain axis. Also alpha synuclein deposition and the associated neurodegeneration in the enteric nervous system that increase intestinal permeability, oxidative stress, and local inflammation, accounts for constipation in Parkinson's disease patients. The trigger that causes blood brain barrier leakage, immune cell activation and inflammation, and ultimately neuroinflammation in the central nervous system is believed to be due to the chronic low-grade inflammation in the gut. The non-motor symptoms that appear years before motor symptoms could be reliable early biomarkers, if they could be correlated with the established and reliable neuroimaging techniques or behavioral indices. The future directions should therefore, focus on the exploration of newer investigational techniques to identify these reliable early biomarkers and define the specific gut microbes that contribute to the development of Parkinson's disease. This ultimately should pave the way to safer and novel therapeutic approaches that avoid the complications of the drugs delivered today to the brain of Parkinson's disease patients.
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Affiliation(s)
- Arun T Nair
- Department of Pharmacology, JSS College of Pharmacy (JSS Academy of Higher Education and Research, Mysuru), Ootacamund, Tamilnadu,
India
| | - Vadivelan Ramachandran
- Department of Pharmacology, JSS College of Pharmacy (JSS Academy of Higher Education and Research, Mysuru), Ootacamund, Tamilnadu,
India
- Correspondence: Vadivelan Ramachandran, PhD, Department of Pharmacology, JSS College of Pharmacy ((JSS Academy of Higher Education and Research, Mysuru), Ootacamund, Tamilnadu 643001, India Tel: +91-9047539532, Fax: +91-423-2442937,
| | - Nanjan M Joghee
- JSS College of Pharmacy (JSS Academy of Higher Education and Research, Mysuru), Ootacamund, Tamilnadu,
India
| | - Shanish Antony
- Department of Pharmacology, Government Medical College, Kottayam, Kerala,
India
| | - Gopalakrishnan Ramalingam
- Department of Pharmacology, JSS College of Pharmacy (JSS Academy of Higher Education and Research, Mysuru), Ootacamund, Tamilnadu,
India
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RIEN M, SCORTEGAGNA SA, GRAZZIOTIN JBDD, BERTOLIN TE. Validity evidence of the Zulliger-CS in older adults with Parkinson’s disease. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2017. [DOI: 10.1590/1982-02752017000400011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract The ethical principles of psychological assessment include the need to use reliable tests to meet the demands of the emerging population. Therefore, the present study sought to provide evidence of validity of the Zulliger Comprehensive System (Zulliger Test in the Comprehensive System) considering the constructs: self-perception and interpersonal relationships. A total of 61 older adults of both sexes participated in the study; 30 had Parkinson’s disease (clinical group) and 31 were healthy (non-clinical group). The clinical group showed an increase in the following variables: Human detail (p = 0.02, d = 0.50); Morbid responses (p = 0.025, d = 0.62); Vista responses (p = 0.016, d = 0.72), Food Responses (p = 0.021, d = 0.61) and Decrease in human detail fictional (p = 0.012, d = -0.65) and in Personalized Responses (p = 0.003, d = -0.48). There was a positive relationship between the Zulliger Test in the Comprehensive System variables and age, income, and disease severity and a negative relationship between the Zulliger Test in the Comprehensive System variables and time since diagnosis. The results obtained confirm the validity of the Zulliger Test in the Comprehensive System and encourage further studies.
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Swallow DMA, Lawton MA, Grosset KA, Malek N, Smith CR, Bajaj NP, Barker RA, Ben-Shlomo Y, Burn DJ, Foltynie T, Hardy J, Morris HR, Williams N, Wood NW, Grosset DG. Variation in Recent Onset Parkinson's Disease: Implications for Prodromal Detection. JOURNAL OF PARKINSONS DISEASE 2017; 6:289-300. [PMID: 27003780 PMCID: PMC4927926 DOI: 10.3233/jpd-150741] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The detection of prodromal Parkinson's disease (PD) is desirable to test drugs with neuroprotective potential, but will be affected by known disease variations. OBJECTIVE To assess the prevalence of four key non-motor prodromal PD markers, and evaluate the sensitivity of case detection when non-motor screening tools for prodromal PD are implemented in an early clinical PD cohort. METHODS Hyposmia (University of Pennsylvania smell identification test ≤15th centile or Sniffin' Sticks at or ≤10th centile corrected for age and sex), rapid-eye movement sleep behaviour disorder (RBD questionnaire >4), constipation (<1 daily spontaneous bowel motion) and depression (Leeds >6) were recorded in recent onset PD cases, and proposed non-motor screening criteria applied. RESULTS In 1,719 PD cases, mean age 68.6 years (SD 8.1), 65.5% male, mean disease duration 1.3 years (SD 0.9), 72.2% were hyposmic, 43.3% had RBD, 22.1% depression, and 21.5% constipation. 11.6% of cases had no key non-motor features, 38.8% one, 32.1% two, 15.5% three, and 2.0% all four. Increasing numbers of non-motor features were associated with younger age (p = 0.019), higher motor scores (p < 0.001), more postural instability gait difficulty (PIGD) (p < 0.001), greater cognitive impairment (p < 0.001) and higher total non-motor burden (p < 0.001). Cases with hyposmia alone were younger (p < 0.001), had less severe cognitive (p = 0.006) and other non-motor features (p < 0.001). All screening criteria selected younger patients (p = 0.001, p < 0.001), three of four greater overall non-motor burden (p = 0.005, p < 0.001), and inclusion of RBD more cognitive impairment (p = 0.003, p = 0.001) and PIGD (p = 0.004, p = 0.001). CONCLUSIONS Varying sensitivity levels, and age and phenotype selectivity, are found when different non-motor screening methods to detect prodromal PD are applied to an early clinical PD cohort.
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Affiliation(s)
- Diane M A Swallow
- Department of Neurology, Institute of Neurological Sciences, Glasgow, UK
| | - Michael A Lawton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Naveed Malek
- Department of Neurology, Institute of Neurological Sciences, Glasgow, UK
| | - Callum R Smith
- Department of Neurology, Institute of Neurological Sciences, Glasgow, UK
| | - Nin P Bajaj
- Department of Neurology, Queen's Medical Centre, Nottingham, UK
| | - Roger A Barker
- Clinical Neurosciences, John van Geest Centre for Brain Repair, Cambridge, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David J Burn
- Institute of Neuroscience, University of Newcastle, UK
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK
| | - John Hardy
- Reta Lila Weston Laboratories, Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Huw R Morris
- Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
| | - Nigel Williams
- Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Nicholas W Wood
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Donald G Grosset
- Department of Neurology, Institute of Neurological Sciences, Glasgow, UK
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Obeso J, Stamelou M, Goetz C, Poewe W, Lang A, Weintraub D, Burn D, Halliday G, Bezard E, Przedborski S, Lehericy S, Brooks D, Rothwell J, Hallett M, DeLong M, Marras C, Tanner C, Ross G, Langston J, Klein C, Bonifati V, Jankovic J, Lozano A, Deuschl G, Bergman H, Tolosa E, Rodriguez-Violante M, Fahn S, Postuma R, Berg D, Marek K, Standaert D, Surmeier D, Olanow C, Kordower J, Calabresi P, Schapira A, Stoessl A. Past, present, and future of Parkinson's disease: A special essay on the 200th Anniversary of the Shaking Palsy. Mov Disord 2017; 32:1264-1310. [PMID: 28887905 PMCID: PMC5685546 DOI: 10.1002/mds.27115] [Citation(s) in RCA: 479] [Impact Index Per Article: 68.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/27/2017] [Indexed: 12/12/2022] Open
Abstract
This article reviews and summarizes 200 years of Parkinson's disease. It comprises a relevant history of Dr. James Parkinson's himself and what he described accurately and what he missed from today's perspective. Parkinson's disease today is understood as a multietiological condition with uncertain etiopathogenesis. Many advances have occurred regarding pathophysiology and symptomatic treatments, but critically important issues are still pending resolution. Among the latter, the need to modify disease progression is undoubtedly a priority. In sum, this multiple-author article, prepared to commemorate the bicentenary of the shaking palsy, provides a historical state-of-the-art account of what has been achieved, the current situation, and how to progress toward resolving Parkinson's disease. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- J.A. Obeso
- HM CINAC, Hospital Universitario HM Puerta del Sur, Mostoles, Madrid, Spain
- Universidad CEU San Pablo, Madrid, Spain
- CIBERNED, Madrid, Spain
| | - M. Stamelou
- Department of Neurology, Philipps University, Marburg, Germany
- Parkinson’s Disease and Movement Disorders Department, HYGEIA Hospital and Attikon Hospital, University of Athens, Athens, Greece
| | - C.G. Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - W. Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - A.E. Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J Safra Program in Parkinson’s Disease, Toronto Western Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - D. Weintraub
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Parkinson’s Disease and Mental Illness Research, Education and Clinical Centers (PADRECC and MIRECC), Corporal Michael J. Crescenz Veteran’s Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - D. Burn
- Medical Sciences, Newcastle University, Newcastle, UK
| | - G.M. Halliday
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia
- School of Medical Sciences, University of New South Wales and Neuroscience Research Australia, Sydney, Australia
| | - E. Bezard
- Université de Bordeaux, Institut des Maladies Neurodégénératives, Centre National de la Recherche Scientifique Unité Mixte de Recherche 5293, Institut des Maladies Neurodégénératives, Bordeaux, France
- China Academy of Medical Sciences, Institute of Lab Animal Sciences, Beijing, China
| | - S. Przedborski
- Departments of Neurology, Pathology, and Cell Biology, the Center for Motor Neuron Biology and Disease, Columbia University, New York, New York, USA
- Columbia Translational Neuroscience Initiative, Columbia University, New York, New York, USA
| | - S. Lehericy
- Institut du Cerveau et de la Moelle épinière – ICM, Centre de NeuroImagerie de Recherche – CENIR, Sorbonne Universités, UPMC Univ Paris 06, Inserm U1127, CNRS UMR 7225, Paris, France
- Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - D.J. Brooks
- Clinical Sciences Department, Newcastle University, Newcastle, UK
- Department of Nuclear Medicine, Aarhus University, Aarhus, Denmark
| | - J.C. Rothwell
- Human Neurophysiology, Sobell Department, UCL Institute of Neurology, London, UK
| | - M. Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - M.R. DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C. Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson’s disease, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - C.M. Tanner
- Movement Disorders and Neuromodulation Center, Department of Neurology, University of California–San Francisco, San Francisco, California, USA
- Parkinson’s Disease Research, Education and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - G.W. Ross
- Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii, USA
| | | | - C. Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - V. Bonifati
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J. Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - A.M. Lozano
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - G. Deuschl
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Christian Albrechts University Kiel, Kiel, Germany
| | - H. Bergman
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, Jerusalem, Israel
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
- Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
| | - E. Tolosa
- Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Medicine, Universitat de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - M. Rodriguez-Violante
- Movement Disorders Clinic, Clinical Neurodegenerative Research Unit, Mexico City, Mexico
- Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - S. Fahn
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - R.B. Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada
| | - D. Berg
- Klinikfür Neurologie, UKSH, Campus Kiel, Christian-Albrechts-Universität, Kiel, Germany
| | - K. Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - D.G. Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D.J. Surmeier
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - C.W. Olanow
- Departments of Neurology and Neuroscience, Mount Sinai School of Medicine, New York, New York, USA
| | - J.H. Kordower
- Research Center for Brain Repair, Rush University Medical Center, Chicago, Illinois, USA
- Neuroscience Graduate Program, Rush University Medical Center, Chicago, Illinois, USA
| | - P. Calabresi
- Neurological Clinic, Department of Medicine, Hospital Santa Maria della Misericordia, University of Perugia, Perugia, Italy
- Laboratory of Neurophysiology, Santa Lucia Foundation, IRCCS, Rome, Italy
| | - A.H.V. Schapira
- University Department of Clinical Neurosciences, UCL Institute of Neurology, University College London, London, UK
| | - A.J. Stoessl
- Pacific Parkinson’s Research Centre, Division of Neurology & Djavadf Mowafaghian Centre for Brain Health, University of British Columbia, British Columbia, Canada
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Olfactory Dysfunction as an Early Biomarker in Parkinson's Disease. Neurosci Bull 2017; 33:515-525. [PMID: 28831680 DOI: 10.1007/s12264-017-0170-x] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/01/2017] [Indexed: 12/31/2022] Open
Abstract
Olfactory dysfunction is common in Parkinson's disease (PD) and often predates the diagnosis by years, reflecting early deposition of Lewy pathology, the histologic hallmark of PD, in the olfactory bulb. Clinical tests are available that allow for the rapid characterization of olfactory dysfunction, including tests of odor identification, discrimination, detection, and recognition thresholds, memory, and tests assessing the build-up of odor intensity across increasing suprathreshold stimulus concentrations. The high prevalence of olfactory impairment, along with the ease and low cost of assessment, has fostered great interest in olfaction as a potential biomarker for PD. Hyposmia may help differentiate PD from other causes of parkinsonism, and may also aid in the identification of "pre-motor" PD due to the early pathologic involvement of olfactory pathways. Olfactory function is also correlated with other non-motor features of PD and may serve as a predictor of cognitive decline. In this article, we summarize the existing literature on olfaction in PD, focusing on the potential for olfaction as a biomarker for early or differential diagnosis and prognosis.
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Picillo M, Barone P, Pellecchia MT. Merging Clinical and Imaging Biomarkers to Tackle Parkinson's Disease. Mov Disord Clin Pract 2017; 4:652-662. [PMID: 30363377 DOI: 10.1002/mdc3.12521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/19/2017] [Accepted: 06/27/2017] [Indexed: 02/05/2023] Open
Abstract
Background In Parkinson's disease, biomarkers represent tools that are potentially suitable for either clinical or research settings and are useful in predicting onset, confirming diagnosis, detecting progression, and evaluating response to potential disease-modifying treatments. The range of available biomarkers in Parkinson's disease is fast expanding and includes an increasing amount of laboratory, clinical, and imaging data. Indeed, the latter 2 represent the cornerstones of the diagnostic criteria for Parkinson's disease recently proposed by the International Parkinson and Movement Disorders Society Task Force on the definition of Parkinson's disease. Methods and Results In this review, we describe current knowledge and emerging findings on clinical (with emphasis on nonmotor symptoms) and imaging biomarkers for Parkinson's disease, with a focus on prodromal, diagnostic, and middle/advanced phases. Conclusion An increasing body of evidence suggests that merging clinical and imaging biomarkers through disease stages may be the best, fastest track to tackle Parkinson's disease.
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Affiliation(s)
- Marina Picillo
- Neuroscience Section Department of Medicine and Surgery Center for Neurodegenerative Diseases (CMAND) University of Salerno Salerno Italy
| | - Paolo Barone
- Neuroscience Section Department of Medicine and Surgery Center for Neurodegenerative Diseases (CMAND) University of Salerno Salerno Italy
| | - Maria Teresa Pellecchia
- Neuroscience Section Department of Medicine and Surgery Center for Neurodegenerative Diseases (CMAND) University of Salerno Salerno Italy
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Ma C, Liu Y, Neumann S, Gao X. Nicotine from cigarette smoking and diet and Parkinson disease: a review. Transl Neurodegener 2017; 6:18. [PMID: 28680589 PMCID: PMC5494127 DOI: 10.1186/s40035-017-0090-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/27/2017] [Indexed: 01/10/2023] Open
Abstract
Evidence from epidemiological studies suggest a relationship between cigarette smoking and low risk of Parkinson disease (PD). As a major component of tobacco smoke, nicotine has been proposed to be a substance for preventing against PD risk, with a key role in regulating striatal activity and behaviors mediated through the dopaminergic system. Animal studies also showed that nicotine could modulate dopamine transmission and reduce levodopa-induced dyskinesias. However, previous clinical trials yield controversial results regarding nicotine treatment. In this review, we updated epidemiological, preclinical and clinical data, and studies on nicotine from diet. We also reviewed interactions between genetic factors and cigarette smoking. As a small amount of nicotine can saturate a substantial portion of nicotine receptors in the brain, nicotine from other sources, such as diet, could be a promising therapeutic substance for protection against PD.
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Affiliation(s)
- Chaoran Ma
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, University Park, PA USA
| | - Yesong Liu
- Department of Neurology, Kailuan General Hospital, Tangshan, China
| | - Samantha Neumann
- Eberly College of Science, The Pennsylvania State University, University Park, University Park, PA USA
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, University Park, PA USA
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Iranzo A, Stefani A, Serradell M, Martí MJ, Lomeña F, Mahlknecht P, Stockner H, Gaig C, Fernández-Arcos A, Poewe W, Tolosa E, Högl B, Santamaria J. Characterization of patients with longstanding idiopathic REM sleep behavior disorder. Neurology 2017; 89:242-248. [PMID: 28615430 DOI: 10.1212/wnl.0000000000004121] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/24/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the presence of prodromal markers of Parkinson disease (PD) in patients with longstanding idiopathic REM sleep behavior disorder (IRBD), a small subgroup of individuals with IRBD with long-term follow-up thought not to be at risk of developing PD. METHODS Demographic, clinical, and neuroimaging markers of PD were evaluated in 20 patients with polysomnographic-confirmed longstanding IRBD and in 32 matched controls. RESULTS Patients were 16 men and 4 women with mean age of 72.9 ± 8.6 years and mean follow-up from IRBD diagnosis of 12.1 ± 2.6 years. Patients more often had objective smell loss (35% vs 3.4%, p = 0.003), constipation (50% vs 15.6%, p = 0.008), and mild parkinsonian signs (45% vs 18.8%, p = 0.042) than controls. Unified Parkinson's Disease Rating Scale motor score was higher in patients than in controls (5.6 ± 3.5 vs 2.0 ± 2.1, p < 0.0001). Dopamine transporter imaging showed decreased striatal uptake in 82.4% of the patients and transcranial sonography found substantia nigra hyperechogenicity in 35.3%. α-Synuclein aggregates were found in 3 of 6 patients who underwent colon or submandibular gland biopsies. All 20 patients showed clinical, neuroimaging, or histologic markers of PD. Probability of prodromal PD (according to recent Movement Disorders Society research criteria) was higher in patients than in controls (<0.0001), and 45% of patients surpassed 80% probability. CONCLUSIONS Prodromal PD markers are common in individuals with longstanding IRBD, suggesting that they are affected by an underlying neurodegenerative process. This observation may be useful for the design of disease-modifying trials to prevent PD onset in IRBD.
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Affiliation(s)
- Alex Iranzo
- From the Neurology Service (A.I., M.S., M.J.M., C.G., A.F.-A., E.T., J.S.) and Nuclear Medicine Service (F.L.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; and Department of Neurology (A.S., P.M., H.S., W.P., B.H.), Medical University Innsbruck, Austria.
| | - Ambra Stefani
- From the Neurology Service (A.I., M.S., M.J.M., C.G., A.F.-A., E.T., J.S.) and Nuclear Medicine Service (F.L.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; and Department of Neurology (A.S., P.M., H.S., W.P., B.H.), Medical University Innsbruck, Austria
| | - Monica Serradell
- From the Neurology Service (A.I., M.S., M.J.M., C.G., A.F.-A., E.T., J.S.) and Nuclear Medicine Service (F.L.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; and Department of Neurology (A.S., P.M., H.S., W.P., B.H.), Medical University Innsbruck, Austria
| | - Maria Jose Martí
- From the Neurology Service (A.I., M.S., M.J.M., C.G., A.F.-A., E.T., J.S.) and Nuclear Medicine Service (F.L.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; and Department of Neurology (A.S., P.M., H.S., W.P., B.H.), Medical University Innsbruck, Austria
| | - Francisco Lomeña
- From the Neurology Service (A.I., M.S., M.J.M., C.G., A.F.-A., E.T., J.S.) and Nuclear Medicine Service (F.L.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; and Department of Neurology (A.S., P.M., H.S., W.P., B.H.), Medical University Innsbruck, Austria
| | - Philipp Mahlknecht
- From the Neurology Service (A.I., M.S., M.J.M., C.G., A.F.-A., E.T., J.S.) and Nuclear Medicine Service (F.L.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; and Department of Neurology (A.S., P.M., H.S., W.P., B.H.), Medical University Innsbruck, Austria
| | - Heike Stockner
- From the Neurology Service (A.I., M.S., M.J.M., C.G., A.F.-A., E.T., J.S.) and Nuclear Medicine Service (F.L.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; and Department of Neurology (A.S., P.M., H.S., W.P., B.H.), Medical University Innsbruck, Austria
| | - Carles Gaig
- From the Neurology Service (A.I., M.S., M.J.M., C.G., A.F.-A., E.T., J.S.) and Nuclear Medicine Service (F.L.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; and Department of Neurology (A.S., P.M., H.S., W.P., B.H.), Medical University Innsbruck, Austria
| | - Ana Fernández-Arcos
- From the Neurology Service (A.I., M.S., M.J.M., C.G., A.F.-A., E.T., J.S.) and Nuclear Medicine Service (F.L.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; and Department of Neurology (A.S., P.M., H.S., W.P., B.H.), Medical University Innsbruck, Austria
| | - Werner Poewe
- From the Neurology Service (A.I., M.S., M.J.M., C.G., A.F.-A., E.T., J.S.) and Nuclear Medicine Service (F.L.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; and Department of Neurology (A.S., P.M., H.S., W.P., B.H.), Medical University Innsbruck, Austria
| | - Eduard Tolosa
- From the Neurology Service (A.I., M.S., M.J.M., C.G., A.F.-A., E.T., J.S.) and Nuclear Medicine Service (F.L.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; and Department of Neurology (A.S., P.M., H.S., W.P., B.H.), Medical University Innsbruck, Austria
| | - Birgit Högl
- From the Neurology Service (A.I., M.S., M.J.M., C.G., A.F.-A., E.T., J.S.) and Nuclear Medicine Service (F.L.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; and Department of Neurology (A.S., P.M., H.S., W.P., B.H.), Medical University Innsbruck, Austria
| | - Joan Santamaria
- From the Neurology Service (A.I., M.S., M.J.M., C.G., A.F.-A., E.T., J.S.) and Nuclear Medicine Service (F.L.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; and Department of Neurology (A.S., P.M., H.S., W.P., B.H.), Medical University Innsbruck, Austria
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Postuma RB. Nonmotor Aspects of Parkinson's Disease-How Do They Help Diagnosis? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:519-539. [PMID: 28802931 DOI: 10.1016/bs.irn.2017.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Not only are nonmotor aspects of Parkinson's disease important because of their impact, they also can help diagnose Parkinson's. This chapter summarizes the ways in which recognition of the nonmotor profile of Parkinson's can help in clinical diagnosis. It also emphasizes the essential role that nonmotor Parkinson's disease plays in the diagnosis of prodromal stages of disease.
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Pilotto A, Heinzel S, Suenkel U, Lerche S, Brockmann K, Roeben B, Schaeffer E, Wurster I, Yilmaz R, Liepelt-Scarfone I, von Thaler AK, Metzger FG, Eschweiler GW, Postuma RB, Maetzler W, Berg D. Application of the movement disorder society prodromal Parkinson's disease research criteria in 2 independent prospective cohorts. Mov Disord 2017; 32:1025-1034. [DOI: 10.1002/mds.27035] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/27/2017] [Accepted: 03/30/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Andrea Pilotto
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
- Neurology Unit, Department of Clinical and Experimental Sciences; University of Brescia, Brescia, Italy and Parkinson's Disease Rehabilitation Centre, FERB ONLUS S.Isidoro Hospital, Trescore Balneario (BG); Italy
| | - Sebastian Heinzel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
| | - Ulrike Suenkel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Stefanie Lerche
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Kathrin Brockmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Eva Schaeffer
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
| | - Isabel Wurster
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Rezzak Yilmaz
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
- German Center for Neurodegenerative Diseases; Tuebingen Germany
| | - Anna-Katharina von Thaler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
| | - Florian G. Metzger
- Department of Psychiatry and Psychotherapy, Geriatric Center; Tuebingen University Hospital; Tuebingen Germany
| | - Gerhard W. Eschweiler
- Department of Psychiatry and Psychotherapy, Geriatric Center; Tuebingen University Hospital; Tuebingen Germany
| | - Ron B. Postuma
- Department of Neurology; Montreal General Hospital; Montreal Quebec Canada
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research; University of Tuebingen; Tuebingen Germany
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
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Fereshtehnejad SM, Montplaisir JY, Pelletier A, Gagnon JF, Berg D, Postuma RB. Validation of the MDS research criteria for prodromal Parkinson's disease: Longitudinal assessment in a REM sleep behavior disorder (RBD) cohort. Mov Disord 2017; 32:865-873. [DOI: 10.1002/mds.26989] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/02/2017] [Accepted: 02/28/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Department of Neurology and Neurosurgery; McGill University; Montreal Québec Canada
- Division of Clinical Geriatrics; Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet; Stockholm Sweden
| | - Jacques Y. Montplaisir
- Centre for Advanced Research in Sleep Medicine; Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
- Department of Psychiatry; Université de Montréal; Montreal Québec Canada
| | - Amelie Pelletier
- Research Institute of the McGill University Health Centre, Montreal General Hospital, Department of Neurology; Montreal Québec Canada
| | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine; Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
- Department of Psychology; Université du Québec à Montréal; Montreal Québec Canada
| | - Daniela Berg
- Department of Neurology; Christian-Albrechts-University; Kiel Germany
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research, University of Tuebingen; Tuebingen Germany
| | - Ronald B. Postuma
- Department of Neurology and Neurosurgery; McGill University; Montreal Québec Canada
- Centre for Advanced Research in Sleep Medicine; Hôpital du Sacré-Cœur de Montréal; Montréal Québec Canada
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The underlying mechanism of prodromal PD: insights from the parasympathetic nervous system and the olfactory system. Transl Neurodegener 2017; 6:4. [PMID: 28239455 PMCID: PMC5319081 DOI: 10.1186/s40035-017-0074-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 02/07/2017] [Indexed: 12/13/2022] Open
Abstract
Neurodegeneration of Parkinson's disease (PD) starts in an insidious manner, 30-50% of dopaminergic neurons have been lost in the substantia nigra before clinical diagnosis. Prodromal stage of the disease, during which the disease pathology has started but is insufficient to result in clinical manifestations, offers a valuable window for disease-modifying therapies. The most focused underlying mechanisms linking the pathological pattern and clinical characteristics of prodromal PD are the prion hypothesis of alpha-synuclein and the selective vulnerability of neurons. In this review, we consider the two potential portals, the vagus nerve and the olfactory bulb, through which abnormal alpha-synuclein can access the brain. We review the clinical, pathological and neuroimaging evidence of the parasympathetic nervous system and the olfactory system in the neurodegenerative process and using the two systems as models to discuss the internal homogeneity and heterogeneity of the prodromal stage of PD, including both the clustering and subtyping of symptoms and signs. Finally, we offer some suggestions on future directions for imaging studies in prodromal Parkinson's disease.
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Titova N, Chaudhuri KR. Palliative Care and Nonmotor Symptoms in Parkinson's Disease and Parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1239-1255. [DOI: 10.1016/bs.irn.2017.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
BACKGROUND Over the past several years, the concept of prodromal Parkinson disease (PD) has been increasingly recognized. This term refers to individuals who do not fulfill motor diagnostic criteria for PD, but who have clinical, genetic, or biomarker characteristics suggesting risk of developing PD in the future. Clinical diagnosis of prodromal PD has low specificity, prompting the need for objective biomarkers with higher specificity. In this qualitative review, we discuss objectively defined putative biomarkers for PD and prodromal PD. METHODS We searched Pubmed and Embase for articles pertaining to objective biomarkers for PD and their application in prodromal cohorts. Articles were selected based on relevance and methodology. KEY FINDINGS Objective biomarkers of demonstrated utility in prodromal PD include ligand-based imaging and transcranial sonography. Development of serum, cerebrospinal fluid, and tissue-based biomarkers is underway, but their application in prodromal PD has yet to meaningfully occur. Combining objective biomarkers with clinical or genetic prodromal features increases the sensitivity and specificity for identifying prodromal PD. CONCLUSIONS Several objective biomarkers for prodromal PD show promise but require further study, including their application to and validation in prodromal cohorts followed longitudinally. Accurate identification of prodromal PD will likely require a multimodal approach. (JINS, 2016, 22, 956-967).
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Berg D, Postuma RB, Adler CH, Bloem BR, Chan P, Dubois B, Gasser T, Goetz CG, Halliday G, Joseph L, Lang AE, Liepelt-Scarfone I, Litvan I, Marek K, Obeso J, Oertel W, Olanow CW, Poewe W, Stern M, Deuschl G. MDS research criteria for prodromal Parkinson's disease. Mov Disord 2016; 30:1600-11. [PMID: 26474317 DOI: 10.1002/mds.26431] [Citation(s) in RCA: 815] [Impact Index Per Article: 101.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 12/14/2022] Open
Abstract
This article describes research criteria and probability methodology for the diagnosis of prodromal PD. Prodromal disease refers to the stage wherein early symptoms or signs of PD neurodegeneration are present, but classic clinical diagnosis based on fully evolved motor parkinsonism is not yet possible. Given the lack of clear neuroprotective/disease-modifying therapy for prodromal PD, these criteria were developed for research purposes only. The criteria are based upon the likelihood of prodromal disease being present with probable prodromal PD defined as ≥80% certainty. Certainty estimates rely upon calculation of an individual's risk of having prodromal PD, using a Bayesian naïve classifier. In this methodology, a previous probability of prodromal disease is delineated based upon age. Then, the probability of prodromal PD is calculated by adding diagnostic information, expressed as likelihood ratios. This diagnostic information combines estimates of background risk (from environmental risk factors and genetic findings) and results of diagnostic marker testing. In order to be included, diagnostic markers had to have prospective evidence documenting ability to predict clinical PD. They include motor and nonmotor clinical symptoms, clinical signs, and ancillary diagnostic tests. These criteria represent a first step in the formal delineation of early stages of PD and will require constant updating as more information becomes available.
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Affiliation(s)
- Daniela Berg
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Ronald B Postuma
- Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada
| | - Charles H Adler
- The Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Piu Chan
- Xuanwu Hospital of Capitol of Medical University, Beijing, China
| | | | - Thomas Gasser
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | | | - Glenda Halliday
- Neuroscience Research Australia & University of NSW, Randwick, Australia
| | - Lawrence Joseph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Anthony E Lang
- Division of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie-Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - José Obeso
- University of Navarra-FIMA, Pamplona, Spain
| | - Wolfgang Oertel
- Department of Neurology, Philipps University of Marburg, Marburg, Germany
| | - C Warren Olanow
- Department of Neurology, The Mount Sinai Hospital, New York, New York, USA
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Matthew Stern
- Penn Neurological Institute, Philadelphia, Pennsylvania, USA
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
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