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Kulcsarova K, Skorvanek M. Challenges and Future of the International Parkinson and Movement Disorder Society Prodromal Parkinson's Disease Criteria: Are We On the Right Track? Mov Disord 2024; 39:637-643. [PMID: 38310367 DOI: 10.1002/mds.29724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 02/05/2024] Open
Affiliation(s)
- Kristina Kulcsarova
- Department of Neurology, P. J. Safarik University, Kosice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
- Department of Clinical Neurosciences, University Scientific Park MEDIPARK, P. J. Safarik University, Kosice, Slovakia
| | - Matej Skorvanek
- Department of Neurology, P. J. Safarik University, Kosice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
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Fernando R, Thomas AJ, Hamilton CA, Durcan R, Barker S, Ciafone J, Barnett N, Olsen K, Firbank M, Roberts G, Lloyd J, Petrides G, Colloby S, Allan LM, McKeith IG, O'Brien JT, Taylor JP, Donaghy PC. Identifying parkinsonism in mild cognitive impairment. J Neurol Sci 2024; 458:122941. [PMID: 38422782 DOI: 10.1016/j.jns.2024.122941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/18/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Clinical parkinsonism is a core diagnostic feature for mild cognitive impairment with Lewy bodies (MCI-LB) but can be challenging to identify. A five-item scale derived from the Unified Parkinson's Disease Rating Scale (UPDRS) has been recommended for the assessment of parkinsonism in dementia. This study aimed to determine whether the five-item scale is effective to identify parkinsonism in MCI. METHODS Participants with MCI from two cohorts (n = 146) had a physical examination including the UPDRS and [123I]-FP-CIT SPECT striatal dopaminergic imaging. Participants were classified as having clinical parkinsonism (P+) or no parkinsonism (P-), and with abnormal striatal dopaminergic imaging (D+) or normal imaging (D-). The five-item scale was the sum of UPDRS tremor at rest, bradykinesia, action tremor, facial expression, and rigidity scores. The ability of the scale to differentiate P+D+ and P-D- participants was examined. RESULTS The five-item scale had an AUROC of 0.92 in Cohort 1, but the 7/8 cut-off defined for dementia had low sensitivity to identify P+D+ participants (sensitivity 25%, specificity 100%). Optimal sensitivity and specificity was obtained at a 3/4 cut-off (sensitivity 83%, specificity 88%). In Cohort 2, the five-item scale had an AUROC of 0.97, and the 3/4 cut-off derived from Cohort 1 showed sensitivity of 100% and a specificity of 82% to differentiate P+D+ from P-D- participants. The five-item scale was not effective in differentiating D+ from D- participants. CONCLUSIONS The five-item scale is effective to identify parkinsonism in MCI, but a lower threshold must be used in MCI compared with dementia.
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Affiliation(s)
- Rishira Fernando
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, UK; Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - George Petrides
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Sean Colloby
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Louise M Allan
- Centre for Research in Ageing and Cognitive Health, University of Exeter, UK
| | - Ian G McKeith
- Translational and Clinical Research Institute, Newcastle University, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, UK.
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3
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Maetzler W, Mirelman A, Pilotto A, Bhidayasiri R. Identifying Subtle Motor Deficits Before Parkinson's Disease is Diagnosed: What to Look for? JOURNAL OF PARKINSON'S DISEASE 2024:JPD230350. [PMID: 38363620 DOI: 10.3233/jpd-230350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Motor deficits typical of Parkinson's disease (PD), such as gait and balance disturbances, tremor, reduced arm swing and finger movement, and voice and breathing changes, are believed to manifest several years prior to clinical diagnosis. Here we describe the evidence for the presence and progression of motor deficits in this pre-diagnostic phase in order to provide suggestions for the design of future observational studies for an effective, quantitatively oriented investigation. On the one hand, these future studies must detect these motor deficits in as large (potentially, population-based) cohorts as possible with high sensitivity and specificity. On the other hand, they must describe the progression of these motor deficits in the pre-diagnostic phase as accurately as possible, to support the testing of the effect of pharmacological and non-pharmacological interventions. Digital technologies and artificial intelligence can substantially accelerate this process.
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Affiliation(s)
- Walter Maetzler
- Department of Neurology University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia Hospital, Brescia, Italy
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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4
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Yang YY, Ho MY, Tai CH, Wu RM, Kuo MC, Tseng YJ. FastEval Parkinsonism: an instant deep learning-assisted video-based online system for Parkinsonian motor symptom evaluation. NPJ Digit Med 2024; 7:31. [PMID: 38332372 PMCID: PMC10853559 DOI: 10.1038/s41746-024-01022-x] [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: 09/27/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
The Motor Disorder Society's Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is designed to assess bradykinesia, the cardinal symptoms of Parkinson's disease (PD). However, it cannot capture the all-day variability of bradykinesia outside the clinical environment. Here, we introduce FastEval Parkinsonism ( https://fastevalp.cmdm.tw/ ), a deep learning-driven video-based system, providing users to capture keypoints, estimate the severity, and summarize in a report. Leveraging 840 finger-tapping videos from 186 individuals (103 patients with Parkinson's disease (PD), 24 participants with atypical parkinsonism (APD), 12 elderly with mild parkinsonism signs (MPS), and 47 healthy controls (HCs)), we employ a dilated convolution neural network with two data augmentation techniques. Our model achieves acceptable accuracies (AAC) of 88.0% and 81.5%. The frequency-intensity (FI) value of thumb-index finger distance was indicated as a pivotal hand parameter to quantify the performance. Our model also shows the usability for multi-angle videos, tested in an external database enrolling over 300 PD patients.
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Affiliation(s)
- Yu-Yuan Yang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, No. 1 Roosevelt Rd. Sec. 4, Taipei, 10617, Taiwan, ROC
| | - Ming-Yang Ho
- Department of Computer Science and Information Engineering, National Taiwan University, No. 1 Roosevelt Rd. Sec. 4, Taipei, 10617, Taiwan, ROC
| | - Chung-Hwei Tai
- Department of Neurology, National Taiwan University Hospital, No. 1 Changde St., Zhongzheng Dist., Taipei City, 100229, Taiwan, ROC
| | - Ruey-Meei Wu
- Department of Medicine, National Taiwan University Cancer Center, No. 57, Lane 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City, 106, Taiwan, ROC
| | - Ming-Che Kuo
- Department of Neurology, National Taiwan University Hospital, No. 1 Changde St., Zhongzheng Dist., Taipei City, 100229, Taiwan, ROC.
- Department of Medicine, National Taiwan University Cancer Center, No. 57, Lane 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City, 106, Taiwan, ROC.
| | - Yufeng Jane Tseng
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, No. 1 Roosevelt Rd. Sec. 4, Taipei, 10617, Taiwan, ROC.
- Department of Computer Science and Information Engineering, National Taiwan University, No. 1 Roosevelt Rd. Sec. 4, Taipei, 10617, Taiwan, ROC.
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Buchman AS, Yu L, Oveisgharan S, Zammit AR, Wang T, Shulman JM, VanderHorst V, Nag S, Bennett DA. Parkinson's Disease and Other Alzheimer's Disease and Related Dementia Pathologies and the Progression of Parkinsonism in Older Adults. J Alzheimers Dis 2024; 100:S197-S209. [PMID: 39121125 DOI: 10.3233/jad-240593] [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] [Indexed: 08/11/2024]
Abstract
Background The interrelationship of parkinsonism, Parkinson's disease (PD) and other Alzheimer's disease (AD) and Alzheimer's disease and related dementias (ADRD) pathologies is unclear. Objective We examined the progression of parkinsonian signs in adults with and without parkinsonism, and their underlying brain pathologies. Methods Annual parkinsonian signs were based on a modified Unified Parkinson's Disease Rating Scale. We used linear mixed effects models to compare the progression of parkinsonian signs in 3 groups categorized based on all available clinical evaluations: Group1 (never parkinsonism or clinical PD), Group2 (ever parkinsonism, but never clinical PD), Group3 (ever clinical PD). In decedents, we examined the progression of parkinsonian signs with PD and eight other AD/ADRD pathologies. Results During average follow-up of 8 years, parkinsonian signs on average increased by 7.3% SD/year (N = 3,807). The progression of parkinsonian signs was slowest in Group1 (never parkinsonism or clinical PD), intermediate in Group2, and fastest in Group3. In decedents (n = 1,717) pathologic PD and cerebrovascular (CVD) pathologies were associated with a faster rate of progressive parkinsonian signs (all p values <0.05). However, pathologic PD was rare in adults without clinical PD (Group1, 5%; Group2, 7% versus Group3, 55%). Yet, 70% of adults in Group2 without pathologic PD showed one or more CVD pathologies. In Group2, adults with pathologic PD showed faster progression of parkinsonian signs compared with those without evidence of pathologic PD and their rate of progression was indistinguishable from adults with clinical PD. Conclusions Parkinsonism in old age is more commonly related to cerebrovascular pathologies relative to pathologic PD and only a minority manifest prodromal PD.
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Affiliation(s)
- Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Shahram Oveisgharan
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Andrea R Zammit
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Tianhao Wang
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Joshua M Shulman
- Department of Neurology and Center for Alzheimer's and Neurodegenerative Diseases, Baylor College of Medicine and Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | | | - Sukrit Nag
- Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Van Cauwenberge MGA, Delva A, Vande Casteele T, Laroy M, Radwan A, Vansteelandt K, Van den Stock J, Bouckaert F, Van Laere K, Emsell L, Vandenberghe W, Vandenbulcke M. Mild Motor Signs in Healthy Aging Are Associated with Lower Synaptic Density in the Brain. Mov Disord 2023; 38:1786-1794. [PMID: 37574924 DOI: 10.1002/mds.29570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/17/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVE To investigate whether mild motor signs (MMS) in old age correlate with synaptic density in the brain. BACKGROUND Normal aging is associated with a decline in movement quality and quantity, commonly termed "mild parkinsonian signs" or more recently MMS. Whether MMS stem from global brain aging or pathology within motor circuits remains unresolved. The synaptic vesicle glycoprotein 2A positron emission tomography (PET) ligand 11 C-UCB-J allows the investigation of brain-motor associations at the synaptic level in vivo. METHOD Fifty-eight healthy older adults (≥50 years) were included from two monocentric control cohorts. Brain magnetic resonance imaging and 11 C-UCB-J PET data were available in 54 participants. 11 C-UCB-J PET binding was quantified by standardized uptake value ratio (SUVR) values in grey matter (GM) volumes of interest (VOIs): caudate, putamen, globus pallidus, substantia nigra, thalamus, cerebellum, and the frontal, parietal, temporal, and occipital cortex. Multiple linear regression analyses were performed with Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III score measuring MMS as the dependent variable and mean SUVR values in each VOI as the independent variable with age, Fazekas score (white matter lesion [WML] load), VOI and cohort as covariates. RESULTS Participants (68 ± 7.5 years; 52% female) had an average MDS-UPDRS part III score of 3.3 ± 2.8. The MDS-UPDRS part III score was inversely associated with synaptic density, independently of WML load or GM volume, in the caudate, substantia nigra, thalamus, cerebellum, and parietal, occipital, temporal cortex. Cohen's f2 showed moderate effect sizes for subcortical (range, 0.30-0.35), cortical (0.28-0.35) and cerebellar VOIs (0.31). CONCLUSION MMS in healthy aging are associated with lower synaptic density throughout the brain. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Margot G A Van Cauwenberge
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Aline Delva
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Laboratory for Parkinson Research, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Thomas Vande Casteele
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Maarten Laroy
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Ahmed Radwan
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Kristof Vansteelandt
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Jan Van den Stock
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Koen Van Laere
- Division of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium
| | - Louise Emsell
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
| | - Wim Vandenberghe
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Laboratory for Parkinson Research, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- Department of Neurosciences, Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
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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: 2] [Impact Index Per Article: 2.0] [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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Vale TC, Cardoso FEC, da Silva DJ, Resende EDPF, Maia DP, Cunningham MCQ, Guimarães HC, Machado JCB, Teixeira AL, Caramelli P, Barbosa MT. Clinical and functional correlates of parkinsonism in a population-based sample of individuals aged 75 + : the Pietà study. BMC Neurol 2023; 23:276. [PMID: 37479964 PMCID: PMC10360246 DOI: 10.1186/s12883-023-03290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 06/16/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Parkinsonism is strongly associated with ageing, and many studies have suggested that parkinsonian signs may affect up to half of older adults and is associated with a wide range of adverse health outcomes. We compared clinical and functional characteristics of oldest-old community-dwelling individuals with parkinsonism (parkinsonian group [PG]) to individuals without parkinsonism (non-parkinsonian group [NPG]. METHODS The Pietà study is a population-based study conducted in Caeté, southeast Brazil, involving 607 individuals aged 75 + years submitted to an extensive clinical evaluation. A subset of 65 PG individuals (61.5% women, median age of 82 years) was compared to 542 NPG individuals (64.8% women, median age of 80 years). RESULTS PG individuals had significantly more functional impairment, clinical comorbidities (including number of falls, loss of bladder control and dysphagia) and major depression. Multivariate analysis revealed that older age, higher UPDRSm scores, lower category fluency test (animals/minute) and delayed recall memory scores were associated with PG. This group was also more cognitively impaired, with lower performance than NPG individuals in the Mini-Mental State Examination, category fluency test (animals/minute), clock drawing and in delayed recall (p < 0.001 for all tests). UPDRSm scores were the most contributing factor to cognition that independently explained variability in functionality of the entire sample. CONCLUSION Individuals aged 75 + years with parkinsonism were significantly more clinically and functionally impaired in this population-based sample. Cognitive dysfunction explained most of the loss of functionality in these patients. UPDRS-m scores contributed independently to explain variability in functionality in the whole sample.
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Affiliation(s)
- Thiago Cardoso Vale
- Internal Medicine Department, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil.
- Movement Disorders Unit, Hospital Universitário, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil.
| | - Francisco Eduardo Costa Cardoso
- Movement Disorders Unit, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Danilo Jorge da Silva
- Internal Medicine Department, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Elisa de Paula Franca Resende
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Débora Palma Maia
- Movement Disorders Unit, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Henrique Cerqueira Guimarães
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Antônio Lúcio Teixeira
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maira Tonidandel Barbosa
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
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9
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Wu H, Wu C, Qin J, Zhou C, Tan S, DuanMu X, Guan X, Bai X, Guo T, Wu J, Chen J, Wen J, Cao Z, Gao T, Gu L, Huang P, Zhang B, Xu X, Zhang M. Functional connectome predicting individual gait function and its relationship with molecular architecture in Parkinson's disease. Neurobiol Dis 2023:106216. [PMID: 37385459 DOI: 10.1016/j.nbd.2023.106216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023] Open
Abstract
Gait impairment is a common symptom of Parkinson's disease (PD), but its neural signature remains unclear due to the interindividual variability of gait performance. Identifying a robust gait-brain correlation at the individual level would provide insight into a generalizable neural basis of gait impairment. In this context, this study aimed to detect connectome that can predict individual gait function of PD, and follow-up analyses assess the molecular architecture underlying the connectome by relating it to the neurotransmitter-receptor/transporter density maps. Resting-state functional magnetic resonance imaging was used to detect the functional connectome, and gait function was assessed via a 10 m-walking test. The functional connectome was first detected within drug-naive patients (N = 48) by using connectome-based predictive modeling following cross-validation and then successfully validated within drug-managed patients (N = 30). The results showed that the motor, subcortical, and visual networks played an important role in predicting gait function. The connectome generated from patients failed to predict the gait function of 33 normal controls (NCs) and had distinct connection patterns compared to NCs. The negative connections (connection negatively correlated with 10 m-walking-time) pattern of the PD connectome was associated with the density of the D2 receptor and VAChT transporter. These findings suggested that gait-associated functional alteration induced by PD pathology differed from that induced by aging degeneration. The brain dysfunction related to gait impairment was more commonly found in regions expressing more dopaminergic and cholinergic neurotransmitters, which may aid in developing targeted treatments.
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Affiliation(s)
- Haoting Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Chenqing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jianmei Qin
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Sijia Tan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xiaojie DuanMu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jingwen Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jiaqi Wen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Zhengye Cao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Ting Gao
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Luyan Gu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China.
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10
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Zhou G, Ren J, Rong D, Zhou H, Ning H, Wang H, Pan C, Wang Y, Zhang R, Guo Z, Huang P, Liu W. Monitoring Substantia Nigra Degeneration Using Free Water Imaging across Prodromal and Clinical Parkinson's Disease. Mov Disord 2023; 38:774-782. [PMID: 36947674 DOI: 10.1002/mds.29366] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Substantia nigra (SN) free water has been suggested as a good surrogate marker in Parkinson's disease (PD). However, its usefulness for diagnosing prodromal PD (pPD) and monitoring disease progression warrants further validation. OBJECTIVE The aim was to investigate SN free water values across prodromal and clinical stages of PD. METHODS Four groups were enrolled in this study: 48 healthy controls (HC), 43 pPD patients, 50 de novo PD (dnPD) patients, and 49 medicated PD (mPD) patients. Based on diffusion tensor images, free water maps were calculated, and SN free water values were extracted from the anterior SN (ASN) and posterior SN (PSN). The SN free water values were compared among the four groups, and associations between free water and clinical symptoms were explored. The distinguishing power of PSN free water was evaluated using the receiver operating characteristic curve analysis. Follow-up was performed for 14 pPD patients. RESULTS PSN free water in the pPD group was significantly higher than that in the HC group and significantly lower than that in the dnPD group. Surprisingly, the mPD group showed decreased PSN free water compared to the dnPD group. There was a positive correlation between motor symptoms and PSN free water in the pPD and dnPD groups. Longitudinal analysis showed a significant increase in PSN free water in pPD patients over time. CONCLUSIONS The PSN free water increased from prodromal to early clinical stages, but the trend might be reversed in late disease stages. This biphasic trend should be considered when applying this marker in future studies. © 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)
- Gaiyan Zhou
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Jingru Ren
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Danyan Rong
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Hao Zhou
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Houxu Ning
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Hui Wang
- Department of Neurology, Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang, China
| | - Chenxi Pan
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yajie Wang
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Ronggui Zhang
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Zhiying Guo
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weiguo Liu
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
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11
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Algotsson C, Rosso A, Elmståhl S, Siennicki-Lantz A. Prevalence and functional impact of parkinsonian signs in older adults from the Good Aging in Skåne study. Parkinsonism Relat Disord 2023; 111:105416. [PMID: 37130449 DOI: 10.1016/j.parkreldis.2023.105416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/05/2023] [Accepted: 04/23/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Mild parkinsonian signs (MPS) have been characterized by several definitions, using the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). We aimed to investigate the prevalence of MPS and their association with functional level and comorbidities in the oldest old. METHOD Community-dwelling older adults (n = 559, median age 85, range 80-102 years) were examined regarding MPS, possible parkinsonism (PP) and subthreshold parkinsonism (SP) according to four previously used definitions and concerning the impact of parkinsonian signs on cognitive, physical, and autonomic function. MPS, PP and SP are different terms describing a very similar phenomenon and there is no gradation between these. In two of the four definitions more advanced symptoms were categorized as parkinsonism. RESULTS Median UPDRS score in the whole study group was 10 points (range: 0-58) and was predominated by bradykinesia. MPS/PP/SP were present in 17-85%, and parkinsonism in 33-71% of the cohort. Independently of age and gender, MPS/PP/SP and especially parkinsonism, were associated with a higher risk of fear of falling and accomplished falls, with lower: cognition, ADL, physical activity and quality of life, and with urinary incontinence, obstipation and orthostatic intolerance. CONCLUSIONS In a population of older adults above 80 years, MPS are highly prevalent as well as more advanced symptoms defined as parkinsonism, and only 9-17% of the cohort is symptom-free. Predominance of bradykinesia in the oldest old might indicate a need for revision of MPS definitions to improve their sensibility.
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Affiliation(s)
- Charlotte Algotsson
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Sweden.
| | - Aldana Rosso
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Sweden
| | - Arkadiusz Siennicki-Lantz
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Sweden
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12
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Dutta S, Hornung S, Taha HB, Bitan G. Biomarkers for parkinsonian disorders in CNS-originating EVs: promise and challenges. Acta Neuropathol 2023; 145:515-540. [PMID: 37012443 PMCID: PMC10071251 DOI: 10.1007/s00401-023-02557-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 04/05/2023]
Abstract
Extracellular vesicles (EVs), including exosomes, microvesicles, and oncosomes, are nano-sized particles enclosed by a lipid bilayer. EVs are released by virtually all eukaryotic cells and have been shown to contribute to intercellular communication by transporting proteins, lipids, and nucleic acids. In the context of neurodegenerative diseases, EVs may carry toxic, misfolded forms of amyloidogenic proteins and facilitate their spread to recipient cells in the central nervous system (CNS). CNS-originating EVs can cross the blood-brain barrier into the bloodstream and may be found in other body fluids, including saliva, tears, and urine. EVs originating in the CNS represent an attractive source of biomarkers for neurodegenerative diseases, because they contain cell- and cell state-specific biological materials. In recent years, multiple papers have reported the use of this strategy for identification and quantitation of biomarkers for neurodegenerative diseases, including Parkinson's disease and atypical parkinsonian disorders. However, certain technical issues have yet to be standardized, such as the best surface markers for isolation of cell type-specific EVs and validating the cellular origin of the EVs. Here, we review recent research using CNS-originating EVs for biomarker studies, primarily in parkinsonian disorders, highlight technical challenges, and propose strategies for overcoming them.
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Affiliation(s)
- Suman Dutta
- International Institute of Innovation and Technology, New Town, Kolkata, India
| | - Simon Hornung
- Division of Peptide Biochemistry, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Hash Brown Taha
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California Los Angeles, 635 Charles E. Young Drive South/Gordon 451, Los Angeles, CA, 90095, USA
| | - Gal Bitan
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California Los Angeles, 635 Charles E. Young Drive South/Gordon 451, Los Angeles, CA, 90095, USA.
- Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA.
- Molecular Biology Institute, University of California Los Angeles, Los Angeles, CA, USA.
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13
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Chung JW, Knight CA, Bower AE, Martello JP, Jeka JJ, Burciu RG. Rate control deficits during pinch grip and ankle dorsiflexion in early-stage Parkinson's disease. PLoS One 2023; 18:e0282203. [PMID: 36867628 PMCID: PMC9983837 DOI: 10.1371/journal.pone.0282203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/10/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Much of our understanding of the deficits in force control in Parkinson's disease (PD) relies on findings in the upper extremity. Currently, there is a paucity of data pertaining to the effect of PD on lower limb force control. OBJECTIVE The purpose of this study was to concurrently evaluate upper- and lower-limb force control in early-stage PD and a group of age- and gender-matched healthy controls. METHODS Twenty individuals with PD and twenty-one healthy older adults participated in this study. Participants performed two visually guided, submaximal (15% of maximum voluntary contractions) isometric force tasks: a pinch grip task and an ankle dorsiflexion task. PD were tested on their more affected side and after overnight withdrawal from antiparkinsonian medication. The tested side in controls was randomized. Differences in force control capacity were assessed by manipulating speed-based and variability-based task parameters. RESULTS Compared with controls, PD demonstrated slower rates of force development and force relaxation during the foot task, and a slower rate of relaxation during the hand task. Force variability was similar across groups but greater in the foot than in the hand in both PD and controls. Lower limb rate control deficits were greater in PD with more severe symptoms based on the Hoehn and Yahr stage. CONCLUSIONS Together, these results provide quantitative evidence of an impaired capacity in PD to produce submaximal and rapid force across multiple effectors. Moreover, results suggest that force control deficits in the lower limb may become more severe with disease progression.
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Affiliation(s)
- Jae Woo Chung
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States of America
| | - Christopher A. Knight
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States of America
- Interdisciplinary Neuroscience Graduate Program, University of Delaware, Newark, DE, United States of America
| | - Abigail E. Bower
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States of America
| | - Justin P. Martello
- Department of Neurosciences, Christiana Care Health System, Newark, DE, United States of America
| | - John J. Jeka
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States of America
- Interdisciplinary Neuroscience Graduate Program, University of Delaware, Newark, DE, United States of America
| | - Roxana G. Burciu
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States of America
- Interdisciplinary Neuroscience Graduate Program, University of Delaware, Newark, DE, United States of America
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14
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Paparella G, Cannavacciuolo A, Angelini L, Costa D, Birreci D, Alunni Fegatelli D, Guerra A, Berardelli A, Bologna M. May Bradykinesia Features Aid in Distinguishing Parkinson's Disease, Essential Tremor, And Healthy Elderly Individuals? JOURNAL OF PARKINSON'S DISEASE 2023; 13:1047-1060. [PMID: 37522221 PMCID: PMC10578222 DOI: 10.3233/jpd-230119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Bradykinesia is the hallmark feature of Parkinson's disease (PD); however, it can manifest in other conditions, including essential tremor (ET), and in healthy elderly individuals. OBJECTIVE Here we assessed whether bradykinesia features aid in distinguishing PD, ET, and healthy elderly individuals. METHODS We conducted simultaneous video and kinematic recordings of finger tapping in 44 PD patients, 69 ET patients, and 77 healthy elderly individuals. Videos were evaluated blindly by expert neurologists. Kinematic recordings were blindly analyzed. We calculated the inter-raters agreement and compared data among groups. Density plots assessed the overlapping in the distribution of kinematic data. Regression analyses and receiver operating characteristic curves determined how the kinematics influenced the likelihood of belonging to a clinical score category and diagnostic group. RESULTS The inter-rater agreement was fair (Fleiss K = 0.32). Rater found the highest clinical scores in PD, and higher scores in ET than healthy elderly individuals (p < 0.001). In regard to kinematic analysis, the groups showed variations in movement velocity, with PD presenting the slowest values and ET displaying less velocity than healthy elderly individuals (all ps < 0.001). Additionally, PD patients showed irregular rhythm and sequence effect. However, kinematic data significantly overlapped. Regression analyses showed that kinematic analysis had high specificity in differentiating between PD and healthy elderly individuals. Nonetheless, accuracy decreased when evaluating subjects with intermediate kinematic values, i.e., ET patients. CONCLUSION Despite a considerable degree of overlap, bradykinesia features vary to some extent in PD, ET, and healthy elderly individuals. Our findings have implications for defining bradykinesia and categorizing patients.
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Affiliation(s)
- Giulia Paparella
- IRCCS Neuromed, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | | | - Luca Angelini
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Davide Costa
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Daniele Birreci
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome,Italy
| | - Andrea Guerra
- Parkinson and Movement Disorders Unit, Study Center on Neurodegeneration (CESNE), University of Padua, Padua, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Italy
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