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Morphological basis of Parkinson disease-associated cognitive impairment: an update. J Neural Transm (Vienna) 2022; 129:977-999. [PMID: 35726096 DOI: 10.1007/s00702-022-02522-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/25/2022] [Indexed: 12/15/2022]
Abstract
Cognitive impairment is one of the most salient non-motor symptoms of Parkinson disease (PD) that poses a significant burden on the patients and carers as well as being a risk factor for early mortality. People with PD show a wide spectrum of cognitive dysfunctions ranging from subjective cognitive decline and mild cognitive impairment (MCI) to frank dementia. The mean frequency of PD with MCI (PD-MCI) is 25.8% and the pooled dementia frequency is 26.3% increasing up to 83% 20 years after diagnosis. A better understanding of the underlying pathological processes will aid in directing disease-specific treatment. Modern neuroimaging studies revealed considerable changes in gray and white matter in PD patients with cognitive impairment, cortical atrophy, hypometabolism, dopamine/cholinergic or other neurotransmitter dysfunction and increased amyloid burden, but multiple mechanism are likely involved. Combined analysis of imaging and fluid markers is the most promising method for identifying PD-MCI and Parkinson disease dementia (PDD). Morphological substrates are a combination of Lewy- and Alzheimer-associated and other concomitant pathologies with aggregation of α-synuclein, amyloid, tau and other pathological proteins in cortical and subcortical regions causing destruction of essential neuronal networks. Significant pathological heterogeneity within PD-MCI reflects deficits in various cognitive domains. This review highlights the essential neuroimaging data and neuropathological changes in PD with cognitive impairment, the amount and topographical distribution of pathological protein aggregates and their pathophysiological relevance. Large-scale clinicopathological correlative studies are warranted to further elucidate the exact neuropathological correlates of cognitive impairment in PD and related synucleinopathies as a basis for early diagnosis and future disease-modifying therapies.
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The potential convergence of NLRP3 inflammasome, potassium, and dopamine mechanisms in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:32. [PMID: 35332154 PMCID: PMC8948240 DOI: 10.1038/s41531-022-00293-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/17/2022] [Indexed: 12/21/2022] Open
Abstract
The pathology of Parkinson's disease (PD) is characterized by α-synuclein aggregation, microglia-mediated neuroinflammation, and dopaminergic neurodegeneration in the substantia nigra with collateral striatal dopamine signaling deficiency. Microglial NLRP3 inflammasome activation has been linked independently to each of these facets of PD pathology. The voltage-gated potassium channel Kv1.3, upregulated in microglia by α-synuclein and facilitating potassium efflux, has also been identified as a modulator of neuroinflammation and neurodegeneration in models of PD. Evidence increasingly suggests that microglial Kv1.3 is mechanistically coupled with NLRP3 inflammasome activation, which is contingent on potassium efflux. Potassium conductance also influences dopamine release from midbrain dopaminergic neurons. Dopamine, in turn, has been shown to inhibit NLRP3 inflammasome activation in microglia. In this review, we provide a literature framework for a hypothesis in which Kv1.3 activity-induced NLRP3 inflammasome activation, evoked by stimuli such as α-synuclein, could lead to microglia utilizing dopamine from adjacent dopaminergic neurons to counteract this process and fend off an activated state. If this is the case, a sufficient dopamine supply would ensure that microglia remain under control, but as dopamine is gradually siphoned from the neurons by microglial demand, NLRP3 inflammasome activation and Kv1.3 activity would progressively intensify to promote each of the three major facets of PD pathology: α-synuclein aggregation, microglia-mediated neuroinflammation, and dopaminergic neurodegeneration. Risk factors overlapping to varying degrees to render brain regions susceptible to such a mechanism would include a high density of microglia, an initially sufficient supply of dopamine, and poor insulation of the dopaminergic neurons by myelin.
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Pike AF, Longhena F, Faustini G, van Eik JM, Gombert I, Herrebout MAC, Fayed MMHE, Sandre M, Varanita T, Teunissen CE, Hoozemans JJM, Bellucci A, Veerhuis R, Bubacco L. Dopamine signaling modulates microglial NLRP3 inflammasome activation: implications for Parkinson's disease. J Neuroinflammation 2022; 19:50. [PMID: 35172843 PMCID: PMC8848816 DOI: 10.1186/s12974-022-02410-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 02/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is characterized by the loss of nigral dopaminergic neurons leading to impaired striatal dopamine signaling, α-synuclein- (α-syn-) rich inclusions, and neuroinflammation. Degenerating neurons are surrounded by activated microglia with increased secretion of interleukin-1β (IL-1β), driven largely by the NLRP3 inflammasome. A critical role for microglial NLRP3 inflammasome activation in the progression of both dopaminergic neurodegeneration and α-syn pathology has been demonstrated in parkinsonism mouse models. Fibrillar α-syn activates this inflammasome in mouse and human macrophages, and we have shown previously that the same holds true for primary human microglia. Dopamine blocks microglial NLRP3 inflammasome activation in the MPTP model, but its effects in this framework, highly relevant to PD, remain unexplored in primary human microglia and in other in vivo parkinsonism models. METHODS Biochemical techniques including quantification of IL-1β secretion and confocal microscopy were employed to gain insight into dopamine signaling-mediated inhibition of the NLRP3 inflammasome mechanism in primary human microglia and the SYN120 transgenic mouse model. Dopamine and related metabolites were applied to human microglia together with various inflammasome activating stimuli. The involvement of the receptors through which these catecholamines were predicted to act were assessed with agonists in both species. RESULTS We show in primary human microglia that dopamine, L-DOPA, and high extracellular K+, but not norepinephrine and epinephrine, block canonical, non-canonical, and α-syn-mediated NLRP3 inflammasome-driven IL-1β secretion. This suggests that dopamine acts as an inflammasome inhibitor in human microglia. Accordingly, we provide evidence that dopamine exerts its inhibitory effect through dopamine receptor D1 and D2 (DRD1 and DRD2) signaling. We also show that aged mice transgenic for human C-terminally truncated (1-120) α-syn (SYN120 tg mice) display increased NLRP3 inflammasome activation in comparison to WT mice that is diminished upon DRD1 agonism. CONCLUSIONS Dopamine inhibits canonical, non-canonical, and α-syn-mediated activation of the NLRP3 inflammasome in primary human microglia, as does high extracellular K+. We suggest that dopamine serves as an endogenous repressor of the K+ efflux-dependent microglial NLRP3 inflammasome activation that contributes to dopaminergic neurodegeneration in PD, and that this reciprocation may account for the specific vulnerability of these neurons to disease pathology.
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Affiliation(s)
- Adrianne F Pike
- Department of Clinical Chemistry, Amsterdam Neuroscience, Neurochemistry Laboratory, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Biology, University of Padua, Padua, Italy.
| | - Francesca Longhena
- Pharmacology Division, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Gaia Faustini
- Pharmacology Division, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Jean-Marc van Eik
- Department of Clinical Chemistry, Amsterdam Neuroscience, Neurochemistry Laboratory, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Iris Gombert
- Department of Clinical Chemistry, Amsterdam Neuroscience, Neurochemistry Laboratory, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Maaike A C Herrebout
- Department of Clinical Chemistry, Amsterdam Neuroscience, Neurochemistry Laboratory, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Mona M H E Fayed
- Department of Clinical Chemistry, Amsterdam Neuroscience, Neurochemistry Laboratory, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Michele Sandre
- Department of Biology, University of Padua, Padua, Italy
| | | | - Charlotte E Teunissen
- Department of Clinical Chemistry, Amsterdam Neuroscience, Neurochemistry Laboratory, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jeroen J M Hoozemans
- Department of Pathology, Amsterdam Neuroscience, Neuropathology Laboratory, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Robert Veerhuis
- Department of Clinical Chemistry, Amsterdam Neuroscience, Neurochemistry Laboratory, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Luigi Bubacco
- Department of Biology, University of Padua, Padua, Italy
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Polverino P, Ajčević M, Catalan M, Mazzon G, Bertolotti C, Manganotti P. Brain oscillatory patterns in mild cognitive impairment due to Alzheimer’s and Parkinson’s disease: an exploratory high-density EEG study. Clin Neurophysiol 2022; 138:1-8. [DOI: 10.1016/j.clinph.2022.01.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/08/2021] [Accepted: 01/31/2022] [Indexed: 01/06/2023]
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Adler CH, Beach TG, Zhang N, Shill HA, Driver-Dunckley E, Mehta SH, Atri A, Caviness JN, Serrano G, Shprecher DR, Sue LI, Belden CM. Clinical Diagnostic Accuracy of Early/Advanced Parkinson Disease: An Updated Clinicopathologic Study. Neurol Clin Pract 2021; 11:e414-e421. [PMID: 34484939 DOI: 10.1212/cpj.0000000000001016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/01/2020] [Indexed: 11/15/2022]
Abstract
Objective To update data for diagnostic accuracy of a clinical diagnosis of Parkinson disease (PD) using neuropathologic diagnosis as the gold standard. Methods Data from the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND) were used to determine the predictive value of a clinical PD diagnosis. Two clinical diagnostic confidence levels were used, possible PD (PossPD, never treated or not responsive) and probable PD (ProbPD, 2/3 cardinal clinical signs and responsive to dopaminergic medications). Neuropathologic diagnosis was the gold standard. Results Based on the first visit to AZSAND, 15/54 (27.8%) PossPD participants and 138/163 (84.7%) ProbPD participants had confirmed PD. PD was confirmed in 24/34 (70.6%) ProbPD with <5 years and 114/128 (89.1%) with ≥5 years disease duration. Using the consensus final clinical diagnosis following death, 161/187 (86.1%) ProbPD had neuropathologically confirmed PD. Diagnostic accuracy for ProbPD improved if included motor fluctuations, dyskinesias, and hyposmia, and hyposmia for PossPD. Conclusions This updated study confirmed lower clinical diagnostic accuracy for elderly, untreated or poorly responsive PossPD participants and for ProbPD with <5 years of disease duration, even when medication responsive. Caution continues to be needed when interpreting clinical studies of PD, especially studies of early disease, that do not have autopsy confirmation. Classification of Evidence This study provides Class II evidence that a clinical diagnosis of ProbPD at the first visit identifies participants who will have pathologically confirmed PD with a sensitivity of 82.6% and a specificity of 86.0%.
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Affiliation(s)
- Charles H Adler
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Thomas G Beach
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nan Zhang
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Holly A Shill
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Erika Driver-Dunckley
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Shyamal H Mehta
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Alireza Atri
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - John N Caviness
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Geidy Serrano
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - David R Shprecher
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Lucia I Sue
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Christine M Belden
- Parkinson's Disease and Movement Disorders Center (CHA, EDD, SHM), Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Civin Laboratory for Neuropathology (TGB, GS, LIS), Banner Sun Health Research Institute, Sun City, AZ; Department of Biostatistics (NZ), Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale; Barrow Neurologic Institute (HAS), Phoenix, AZ; Cleo Roberts Center (AA, DRS, CMB), Banner Sun Health Research Institute, Sun City, AZ; and Center for Brain/Mind Medicine (AA), Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Bellomo G, Paolini Paoletti F, Chipi E, Petricciuolo M, Simoni S, Tambasco N, Parnetti L. A/T/(N) Profile in Cerebrospinal Fluid of Parkinson's Disease with/without Cognitive Impairment and Dementia with Lewy Bodies. Diagnostics (Basel) 2020; 10:diagnostics10121015. [PMID: 33256252 PMCID: PMC7760640 DOI: 10.3390/diagnostics10121015] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/14/2020] [Accepted: 11/23/2020] [Indexed: 01/08/2023] Open
Abstract
Neuropathological investigations report that in synucleinopathies with dementia, namely Parkinson's disease (PD) with dementia (PDD) and dementia with Lewy bodies (DLB), the histopathological hallmarks of Alzheimer's Disease (AD), in particular amyloid plaques, are frequently observed. In this study, we investigated the cerebrospinal fluid (CSF) AD biomarkers in different clinical phenotypes of synucleinopathies. CSF Aβ42/Aβ40 ratio, phosphorylated tau and total tau were measured as markers of amyloidosis (A), tauopathy (T) and neurodegeneration (N) respectively, in 98 PD (48 with mild cognitive impairment, PD-MCI; 50 cognitively unimpaired, PD-nMCI), 14 PDD and 15 DLB patients, and 48 neurological controls (CTRL). In our study, CSF AD biomarkers did not significantly differ between CTRL, PD-MCI and PD-nMCI patients. In PD-nMCI and PD-MCI groups, A-/T-/N- profile was the most represented. Prevalence of A+ was similar in PD-nMCI and PD-MCI (10% and 13%, respectively), being higher in PDD (64%) and in DLB (73%). DLB showed the lowest values of Aβ42/Aβ40 ratio. Higher total tau at baseline predicted a worse neuropsychological outcome after one year in PD-MCI. A+/T+, i.e., AD-like CSF profile, was most frequent in the DLB group (40% vs. 29% in PDD).
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Affiliation(s)
- Giovanni Bellomo
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine, University of Perugia, 06132 Perugia (PG), Italy; (G.B.); (M.P.)
| | - Federico Paolini Paoletti
- Section of Neurology, Department of Medicine, University of Perugia, 06132 Perugia (PG), Italy; (F.P.P.); (E.C.); (S.S.); (N.T.)
| | - Elena Chipi
- Section of Neurology, Department of Medicine, University of Perugia, 06132 Perugia (PG), Italy; (F.P.P.); (E.C.); (S.S.); (N.T.)
| | - Maya Petricciuolo
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine, University of Perugia, 06132 Perugia (PG), Italy; (G.B.); (M.P.)
| | - Simone Simoni
- Section of Neurology, Department of Medicine, University of Perugia, 06132 Perugia (PG), Italy; (F.P.P.); (E.C.); (S.S.); (N.T.)
| | - Nicola Tambasco
- Section of Neurology, Department of Medicine, University of Perugia, 06132 Perugia (PG), Italy; (F.P.P.); (E.C.); (S.S.); (N.T.)
| | - Lucilla Parnetti
- Laboratory of Clinical Neurochemistry, Section of Neurology, Department of Medicine, University of Perugia, 06132 Perugia (PG), Italy; (G.B.); (M.P.)
- Section of Neurology, Department of Medicine, University of Perugia, 06132 Perugia (PG), Italy; (F.P.P.); (E.C.); (S.S.); (N.T.)
- Correspondence:
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Knox MG, Adler CH, Shill HA, Driver-Dunckley E, Mehta SA, Belden C, Zamrini E, Serrano G, Sabbagh MN, Caviness JN, Sue LI, Davis KJ, Dugger BN, Beach TG. Neuropathological Findings in Parkinson's Disease With Mild Cognitive Impairment. Mov Disord 2020; 35:845-850. [PMID: 32034933 DOI: 10.1002/mds.27991] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 01/14/2020] [Accepted: 01/17/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE There are few neuropathological studies on Parkinson's disease with mild cognitive impairment (PD-MCI). Those published reveal coexisting Lewy body and Alzheimer's disease pathology. Our objective is to determine the pathology that underlies PD-MCI. METHODS We used data from the Arizona Study of Aging and Neurodegenerative Disorders, a longitudinal clinicopathological study. Of 736 autopsied subjects with standardized movement and cognitive assessments, 25 had PD-MCI. Neuropathological findings, including Lewy body and Alzheimer's disease pathology, were compared in PD subjects with amnestic MCI (A-MCI) and nonamnestic MCI (NA-MCI). RESULTS Significant pathological heterogeneity within PD-MCI was found. This included varying Lewy body stages, Alzheimer's disease pathology, and cerebral amyloid angiopathy. There was a significant increase in the severity of Lewy body pathology (meeting The Unified Staging System for Lewy Body disorders neocortical stage) in nonamnestic MCI (7/1, 63%) when compared with amnestic MCI (3/14, 21%, P = 0.032). CONCLUSION Although a small study, distinct pathological changes may contribute to PD-MCI phenotype. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Molly G Knox
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Charles H Adler
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Holly A Shill
- Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Erika Driver-Dunckley
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Shyamal A Mehta
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Christine Belden
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Edward Zamrini
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Geidy Serrano
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA
| | | | - John N Caviness
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Lucia I Sue
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Kathryn J Davis
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Brittany N Dugger
- Department of Pathology and Laboratory Medicine, University of California-Davis, Davis, California, USA
| | - Thomas G Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA
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Cammisuli DM, Cammisuli SM, Fusi J, Franzoni F, Pruneti C. Parkinson's Disease-Mild Cognitive Impairment (PD-MCI): A Useful Summary of Update Knowledge. Front Aging Neurosci 2019; 11:303. [PMID: 31780918 PMCID: PMC6856711 DOI: 10.3389/fnagi.2019.00303] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 10/23/2019] [Indexed: 11/22/2022] Open
Abstract
Mild cognitive impairment (MCI) is a common feature in Parkinson's Disease (PD), even at the time of diagnosis. Some levels of heterogeneity in nature and severity of cognitive impairment and risk of conversion to Parkinson's Disease Dementia (PDD) exist. This brief overview summarized the current understanding of MCI in PD, by considering the following major points: historical development of the clinical entity, evaluation, epidemiology, predictors and outcomes, neuroimaging findings, pathophysiology, treatment, and pharmacological and non-pharmacological intervention. MCI in PD represents a concept in evolution and plays a pivotal role in advancing our understanding of the disease mechanisms, with the ultimate goal of building effective strategies to prevent conversion into PDD. Challenges for future research are also discussed.
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Affiliation(s)
- Davide Maria Cammisuli
- Laboratories of Clinical Psychology, Clinical Psychophysiology and Clinical Neuropsychology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | | | - Jonathan Fusi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ferdinando Franzoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carlo Pruneti
- Laboratories of Clinical Psychology, Clinical Psychophysiology and Clinical Neuropsychology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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Fellner L, Buchinger E, Brueck D, Irschick R, Wenning GK, Stefanova N. Limited effects of dysfunctional macroautophagy on the accumulation of extracellularly derived α-synuclein in oligodendroglia: implications for MSA pathogenesis. BMC Neurosci 2018; 19:32. [PMID: 29783943 PMCID: PMC5963177 DOI: 10.1186/s12868-018-0431-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/10/2018] [Indexed: 01/08/2023] Open
Abstract
Background The progressive neurodegenerative disorder multiple system atrophy (MSA) is characterized by α-synuclein-positive (oligodendro-) glial cytoplasmic inclusions (GCIs). A connection between the abnormal accumulation of α-synuclein in GCIs and disease initiation and progression has been postulated. Mechanisms involved in the formation of GCIs are unclear. Abnormal uptake of α-synuclein from extracellular space, oligodendroglial overexpression of α-synuclein, and/or dysfunctional protein degradation including macroautophagy have all been discussed. In the current study, we investigated whether dysfunctional macroautophagy aggravates accumulation of extracellular α-synuclein in the oligodendroglia. Results We show that oligodendroglia uptake monomeric and fibrillar extracellular α-synuclein. Blocking macroautophagy through bafilomycin A1 treatment or genetic knockdown of LC3B does not consistently change the level of incorporated α-synuclein in oligodendroglia exposed to extracellular soluble/monomeric or fibrillar α-synuclein, however leads to higher oxidative stress in combination with fibrillar α-synuclein treatment. Finally, we detected no evidence for GCI-like formation resulting from dysfunctional macroautophagy in oligodendroglia using confocal microscopy. Conclusion In summary, isolated dysfunctional macroautophagy is not sufficient to enhance abnormal accumulation of uptaken α-synuclein in vitro, but may lead to increased production of reactive oxygen species in the presence of fibrillar α-synuclein. Multiple complementary pathways are likely to contribute to GCI formation in MSA.
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Affiliation(s)
- Lisa Fellner
- Department of Neurology, Medical University of Innsbruck, Innrain 66, G2, 6020, Innsbruck, Austria.
| | - Edith Buchinger
- Department of Neurology, Medical University of Innsbruck, Innrain 66, G2, 6020, Innsbruck, Austria
| | - Dominik Brueck
- Department of Neurology, Medical University of Innsbruck, Innrain 66, G2, 6020, Innsbruck, Austria
| | - Regina Irschick
- Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innrain 66, G2, 6020, Innsbruck, Austria
| | - Nadia Stefanova
- Department of Neurology, Medical University of Innsbruck, Innrain 66, G2, 6020, Innsbruck, Austria
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Abstract
PURPOSE OF REVIEW Mild cognitive impairment is a common feature of Parkinson's disease, even at the earliest disease stages, but there is variation in the nature and severity of cognitive involvement and in the risk of conversion to Parkinson's disease dementia. This review aims to summarise current understanding of mild cognitive impairment in Parkinson's disease. We consider the presentation, rate of conversion to dementia, underlying pathophysiology and potential biomarkers of mild cognitive impairment in Parkinson's disease. Finally, we discuss challenges and controversies of mild cognitive impairment in Parkinson's disease. RECENT FINDINGS Large-scale longitudinal studies have shown that cognitive involvement is important and common in Parkinson's disease and can present early in the disease course. Recent criteria for mild cognitive impairment in Parkinson's provide the basis for further study of cognitive decline and for the progression of different cognitive phenotypes and risk of conversion to dementia. Improved understanding of the underlying pathology and progression of cognitive change are likely to lead to opportunities for early intervention for this important aspect of Parkinson's disease.
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Affiliation(s)
- Rimona S Weil
- Dementia Research Centre, UCL, London, UK
- Department of Neurodegeneration, UCL, London, UK
| | | | - Anette E Schrag
- Department of Clinical Neuroscience, UCL, London, UK.
- UCL Institute of Neurology, Rowland Hill Street, NW3 2PF, London, UK.
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11
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Hessen E, Stav AL, Auning E, Selnes P, Blomsø L, Holmeide CE, Johansen KK, Eliassen CF, Reinvang I, Fladby T, Aarsland D. Neuropsychological Profiles in Mild Cognitive Impairment due to Alzheimer's and Parkinson's Diseases. JOURNAL OF PARKINSONS DISEASE 2017; 6:413-21. [PMID: 27061068 PMCID: PMC4927809 DOI: 10.3233/jpd-150761] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Neuropsychological comparisons between patients with mild cognitive impairment due to Parkinson’s disease (MCI-PD) and Alzheimer’s disease (MCI-AD) is mostly based on indirect comparison of patients with these disorders and normal controls (NC). Objective: The focus of this study was to make a direct comparison between patients with these diseases. Methods: The study compared 13 patients with MCI-PD and 19 patients with MCI-AD with similar age, education and gender. The participants were recruited and assessed at the same university clinic with equal methods. Results: The main finding was that on group level, MCI-AD scored significantly poorer on learning and memory tests than MCI-PD, whereas MCI-PD were impaired on 1 of 3 measures of executive functioning. Conclusion: MCI-AD performed poorer learning and memory tests, whereas MCI-PD only scored below the employed cut-off on one single executive test. In general, MCI-PD was noticeably less cognitively impaired than MCI-AD.
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Affiliation(s)
- Erik Hessen
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway.,Department of Psychology, University of Oslo, Norway
| | - Ane Løvli Stav
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| | - Eirik Auning
- Department of Geriatric Psychiatry, Akershus University Hospital, Lorenskog, Norway
| | - Per Selnes
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| | - Linn Blomsø
- Department of Psychology, University of Oslo, Norway
| | | | | | - Carl Fredrik Eliassen
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway.,Department of Psychology, University of Oslo, Norway
| | - Ivar Reinvang
- Department of Psychology, University of Oslo, Norway
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway
| | - Dag Aarsland
- Alzheimer's Disease Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Novum, Stockholm, Sweden.,Center for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
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12
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Johar I, Mollenhauer B, Aarsland D. Cerebrospinal Fluid Biomarkers of Cognitive Decline in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:275-294. [PMID: 28554411 DOI: 10.1016/bs.irn.2016.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Among the nonmotor symptoms in Parkinson's disease (PD), cognitive impairment is one of the most common and devastating. Over recent years, mild cognitive impairment (MCI) has become a recognized feature of PD (PD-MCI). The underlying mechanisms which influence onset, rate of decline, and conversion to dementia (PDD) are largely unknown. Adding to this uncertainty is the heterogeneity of cognitive domains affected. Currently there are no disease-modifying treatments that can slow or reverse this process. Identification of biomarkers that can predict rate and risk of cognitive decline is therefore an unmet need. Cerebrospinal fluid (CSF) is an ideal biomarker candidate as its constituents reflect the metabolic processes underlying the functioning of brain parenchyma. The pathological hallmark of PD is the presence of aggregated α-synuclein (α-Syn) in intracellular Lewy inclusions. In addition, there is concomitant Alzheimer's disease (AD) pathology. In AD, decreased CSF β-amyloid 1-42 (Aβ42) and increased CSF tau levels are predictive of future cognitive decline, setting a precedent for such studies to be carried out in PD. CSF studies in PD have focused on the classical AD biomarkers and α-Syn. Longitudinal studies indicate that low levels of CSF Aβ42 are predictive of cognitive decline; however, results for tau and α-Syn were not consistent. This chapter summarizes recent findings of CSF biomarker studies and cognitive dysfunction in PD.
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Affiliation(s)
- Iskandar Johar
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany; University Medical Center, Göttingen, Germany
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
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13
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Brennan L, Devlin KM, Xie SX, Mechanic-Hamilton D, Tran B, Hurtig HH, Chen-Plotkin A, Chahine LM, Morley JF, Duda JE, Roalf DR, Dahodwala N, Rick J, Trojanowski JQ, Moberg PJ, Weintraub D. Neuropsychological Subgroups in Non-Demented Parkinson's Disease: A Latent Class Analysis. JOURNAL OF PARKINSON'S DISEASE 2017; 7:385-395. [PMID: 28387684 PMCID: PMC5548408 DOI: 10.3233/jpd-171081] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Methods to detect early cognitive decline and account for heterogeneity of deficits in Parkinson's disease (PD) are needed. Quantitative methods such as latent class analysis (LCA) offer an objective approach to delineate discrete phenotypes of impairment. OBJECTIVE To identify discrete neurocognitive phenotypes in PD patients without dementia. METHODS LCA was applied to a battery of 8 neuropsychological measures to identify cognitive subtypes in a cohort of 199 non-demented PD patients. Two measures were analyzed from each of four domains: executive functioning, memory, visuospatial abilities, and language. Additional analyses compared groups on clinical characteristics and cognitive diagnosis. RESULTS LCA identified 3 distinct groups of PD patients: an intact cognition group (54.8%), an amnestic group (32.2%), and a mixed impairment group with dysexecutive, visuospatial and lexical retrieval deficits (13.1%). The two impairment groups had significantly lower instrumental activities of daily living ratings and greater motor symptoms than the intact group. Of those diagnosed as cognitively normal according to MDS criteria, LCA classified 23.2% patients as amnestic and 9.9% as mixed cognitive impairment. CONCLUSIONS Non-demented PD patients exhibit distinct neuropsychological profiles. One-third of patients with LCA-determined impairment were diagnosed as cognitively intact by expert consensus, indicating that classification using a statistical algorithm may improve detection of initial and subtle cognitive decline. This study also demonstrates that memory impairment is common in non-demented PD even when cognitive impairment is not clinically apparent. This study has implications for predicting eventual emergence of significant cognitive decline, and treatment trials for cognitive dysfunction in PD.
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Affiliation(s)
- Laura Brennan
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA
| | | | - Sharon X. Xie
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine; Philadelphia, PA
| | - Dawn Mechanic-Hamilton
- Department of Psychiatry, University of Pennsylvania School of Medicine; Philadelphia, PA
| | - Baochan Tran
- Department of Psychology, Widener University
- Department of Neurology, University of Pennsylvania School of Medicine; Philadelphia, PA
| | - Howard H. Hurtig
- Department of Neurology, University of Pennsylvania School of Medicine; Philadelphia, PA
| | - Alice Chen-Plotkin
- Department of Neurology, University of Pennsylvania School of Medicine; Philadelphia, PA
| | - Lama M. Chahine
- Department of Neurology, University of Pennsylvania School of Medicine; Philadelphia, PA
| | - James F. Morley
- Department of Neurology, University of Pennsylvania School of Medicine; Philadelphia, PA
- Parkinson's Disease Research, Education, and Clinical Center, Philadelphia Veterans Affairs Medical Center; Philadelphia, PA
| | - John E. Duda
- Department of Neurology, University of Pennsylvania School of Medicine; Philadelphia, PA
- Parkinson's Disease Research, Education, and Clinical Center, Philadelphia Veterans Affairs Medical Center; Philadelphia, PA
| | - David R. Roalf
- Department of Psychiatry, University of Pennsylvania School of Medicine; Philadelphia, PA
| | - Nabila Dahodwala
- Department of Neurology, University of Pennsylvania School of Medicine; Philadelphia, PA
| | - Jacqueline Rick
- Department of Neurology, University of Pennsylvania School of Medicine; Philadelphia, PA
| | - John Q. Trojanowski
- Department of Pathology, and Laboratory Medicine, University of Pennsylvania School of Medicine; Philadelphia, PA
| | - Paul J. Moberg
- Department of Psychiatry, University of Pennsylvania School of Medicine; Philadelphia, PA
| | - Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania School of Medicine; Philadelphia, PA
- Department of Neurology, University of Pennsylvania School of Medicine; Philadelphia, PA
- Parkinson's Disease Research, Education, and Clinical Center, Philadelphia Veterans Affairs Medical Center; Philadelphia, PA
- Mental Illness Research, Education, and Clinical Center, Philadelphia Veterans Affairs Medical Center; Philadelphia, PA
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14
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Adler CH, Beach TG. Neuropathological basis of nonmotor manifestations of Parkinson's disease. Mov Disord 2016; 31:1114-9. [PMID: 27030013 DOI: 10.1002/mds.26605] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 12/13/2022] Open
Abstract
Nonmotor manifestations of Parkinson's disease (PD) can begin well before motor PD begins. It is now clear, from clinical and autopsy studies, that there is significant Lewy-type α-synucleinopathy present outside the nigro-striatal pathway and that this may underlie these nonmotor manifestations. This review discusses neuropathological findings that may underlie nonmotor symptoms that either predate motor findings or occur as the disease progresses. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Charles H Adler
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Thomas G Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA
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15
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Markers of cognitive decline in PD: The case for heterogeneity. Parkinsonism Relat Disord 2016; 24:8-14. [PMID: 26774536 DOI: 10.1016/j.parkreldis.2016.01.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 01/25/2023]
Abstract
Cognitive impairment is highly prevalent and has a severe negative effect on health related and perceived quality of life in Parkinson's disease (PD). It is now established that 20-40% of persons with PD will develop cognitive deficits early in the disease. Moreover, the risk of developing dementia is six times higher in PD patients than in age-matched controls and it is estimated that 80% of patients will develop dementia after 20 years of the disease. In order to address these symptoms properly it is crucial to identify very early in the disease the patients who are most likely to develop dementia rapidly. Persons who meet criteria for mild cognitive impairment (MCI) exhibit measurable cognitive deficits but those deficits are not severe enough to interfere significantly with daily life. While the presence of MCI in PD increases the chance of developing dementia, various studies suggest that PD-MCI might consist of distinct subtypes with different pathophysiologies and prognoses. In this paper we comment on various biomarkers associated with cognitive decline in PD, specifically clinical, neuropathological, genetic and neuroimaging ones. We also discuss disrupted functional connectivity in PD-MCI and reveal preliminary results from our own group. We propose that the current studies looking at different types of biomarkers provide support for different causes being associated with cognitive decline in PD. Large-scale multi-disciplinary and multi-modal longitudinal studies are required to identify more specifically the different phenotypes associated with different cognitive profiles and evolution in PD.
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16
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Shin NY, Shin YS, Lee PH, Yoon U, Han S, Kim DJ, Lee SK. Different Functional and Microstructural Changes Depending on Duration of Mild Cognitive Impairment in Parkinson Disease. AJNR Am J Neuroradiol 2015; 37:897-903. [PMID: 26705323 DOI: 10.3174/ajnr.a4626] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/26/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The higher cortical burden of Lewy body and Alzheimer disease-type pathology has been reported to be associated with a faster onset of cognitive impairment of Parkinson disease. So far, there has been a few studies only about the changes of gray matter volume depending on duration of cognitive impairment in Parkinson disease. Therefore, our aim was to evaluate the different patterns of structural and functional changes in Parkinson disease with mild cognitive impairment according to the duration of parkinsonism before mild cognitive impairment. MATERIALS AND METHODS Fifty-nine patients with Parkinson disease with mild cognitive impairment were classified into 2 groups on the basis of shorter (<1 year, n = 16) and longer (≥1 year, n = 43) durations of parkinsonism before mild cognitive impairment. Fifteen drug-naïve patients with de novo Parkinson disease with intact cognition were included for comparison. Cortical thickness, Tract-Based Spatial Statistics, and seed-based resting-state functional connectivity analyses were performed. Age, sex, years of education, age at onset of parkinsonism, and levodopa-equivalent dose were included as covariates. RESULTS The group with shorter duration of parkinsonism before mild cognitive impairment showed decreased fractional anisotropy and increased mean and radial diffusivity values in the frontal areas compared with the group with longer duration of parkinsonism before mild cognitive impairment (corrected P < .05). The group with shorter duration of parkinsonism before mild cognitive impairment showed decreased resting-state functional connectivity in the default mode network area when the left or right posterior cingulate was used as a seed, and in the dorsolateral prefrontal areas when the left or right caudate was used as a seed (corrected P < .05). The group with longer duration of parkinsonism before mild cognitive impairment showed decreased resting-state functional connectivity mainly in the medial prefrontal cortex when the left or right posterior cingulate was used as a seed, and in the parieto-occipital areas when the left or right caudate was used as a seed (corrected P < .05). No differences in cortical thickness were found in all group contrasts. CONCLUSIONS Resting-state functional connectivity and WM alterations might be useful imaging biomarkers for identifying changes in patients with Parkinson disease with mild cognitive impairment according to the duration of parkinsonism before mild cognitive impairment. The functional and microstructural substrates may topographically differ depending on the rate of cognitive decline in these patients.
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Affiliation(s)
- N-Y Shin
- From the Department of Radiology (N.-Y.S.), Ewha Womans University School of Medicine, Seoul, Korea Radiology (N.-Y.S., D.J.K., S.-K.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Y S Shin
- Department of Psychology (Y.S.S., S.H.), Yonsei University, Seoul, Korea
| | - P H Lee
- Departments of Neurology (P.H.L.)
| | - U Yoon
- Department of Biomedical Engineering (U.Y.), College of Health and Medical Science, Catholic University of Daegu, Gyeongsan-si, South Korea
| | - S Han
- Department of Psychology (Y.S.S., S.H.), Yonsei University, Seoul, Korea
| | - D J Kim
- Radiology (N.-Y.S., D.J.K., S.-K.L.), Yonsei University College of Medicine, Seoul, Korea
| | - S-K Lee
- Radiology (N.-Y.S., D.J.K., S.-K.L.), Yonsei University College of Medicine, Seoul, Korea
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17
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Goldman JG, Aggarwal NT, Schroeder CD. Mild cognitive impairment: an update in Parkinson's disease and lessons learned from Alzheimer's disease. Neurodegener Dis Manag 2015; 5:425-43. [PMID: 26517759 DOI: 10.2217/nmt.15.34] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Cognitive dysfunction is an important focus of research in Parkinson's disease (PD) and Alzheimer's disease (AD). While the concept of amnestic mild cognitive impairment (MCI) as a prodrome to AD has been recognized for many years, the construct of MCI in PD is a relative newcomer with recent development of diagnostic criteria, biomarker research programs and treatment trials. Controversies and challenges, however, regarding PD-MCI's definition, application, heterogeneity and different trajectories have arisen. This review will highlight current research advances and challenges in PD-MCI. Furthermore, lessons from the AD field, which has witnessed an evolution in MCI/AD definitions, relevant advances in biomarker research and development of disease-modifying and targeted therapeutic trials will be discussed.
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Affiliation(s)
- Jennifer G Goldman
- Rush University Medical Center, Department of Neurological Sciences, Section of Parkinson Disease & Movement Disorders, 1725 W. Harrison Street, Suite 755, Chicago, IL 60612, USA
| | - Neelum T Aggarwal
- Rush University Medical Center, Department of Neurological Sciences & Rush Alzheimer's Disease Center, 600 South Paulina, Suite 1038, Chicago, IL 60612, USA
| | - Cynthia D Schroeder
- Rush University Medical Center, Department of Neurological Sciences, 1735 W. Harrison Street, Suite 306, Chicago, IL 60612, USA
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18
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Boison D, Aronica E. Comorbidities in Neurology: Is adenosine the common link? Neuropharmacology 2015; 97:18-34. [PMID: 25979489 PMCID: PMC4537378 DOI: 10.1016/j.neuropharm.2015.04.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 12/13/2022]
Abstract
Comorbidities in Neurology represent a major conceptual and therapeutic challenge. For example, temporal lobe epilepsy (TLE) is a syndrome comprised of epileptic seizures and comorbid symptoms including memory and psychiatric impairment, depression, and sleep dysfunction. Similarly, Alzheimer's disease (AD), Parkinson's disease (PD), and Amyotrophic Lateral Sclerosis (ALS) are accompanied by various degrees of memory dysfunction. Patients with AD have an increased likelihood for seizures, whereas all four conditions share certain aspects of psychosis, depression, and sleep dysfunction. This remarkable overlap suggests common pathophysiological mechanisms, which include synaptic dysfunction and synaptotoxicity, as well as glial activation and astrogliosis. Astrogliosis is linked to synapse function via the tripartite synapse, but astrocytes also control the availability of gliotransmitters and adenosine. Here we will specifically focus on the 'adenosine hypothesis of comorbidities' implying that astrocyte activation, via overexpression of adenosine kinase (ADK), induces a deficiency in the homeostatic tone of adenosine. We present evidence from patient-derived samples showing astrogliosis and overexpression of ADK as common pathological hallmark of epilepsy, AD, PD, and ALS. We discuss a transgenic 'comorbidity model', in which brain-wide overexpression of ADK and resulting adenosine deficiency produces a comorbid spectrum of seizures, altered dopaminergic function, attentional impairment, and deficits in cognitive domains and sleep regulation. We conclude that dysfunction of adenosine signaling is common in neurological conditions, that adenosine dysfunction can explain co-morbid phenotypes, and that therapeutic adenosine augmentation might be effective for the treatment of comorbid symptoms in multiple neurological conditions.
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Affiliation(s)
- Detlev Boison
- Robert Stone Dow Neurobiology Laboratories, Legacy Research Institute, Portland, OR 97232, USA.
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Academic Medical Center and Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, The Netherlands; Stichting Epilepsie Instellingen (SEIN) Nederland, Heemstede, The Netherlands
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19
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Stav AL, Aarsland D, Johansen KK, Hessen E, Auning E, Fladby T. Amyloid-β and α-synuclein cerebrospinal fluid biomarkers and cognition in early Parkinson's disease. Parkinsonism Relat Disord 2015; 21:758-64. [DOI: 10.1016/j.parkreldis.2015.04.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/14/2015] [Accepted: 04/22/2015] [Indexed: 01/06/2023]
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20
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Halliday GM, Leverenz JB, Schneider JS, Adler CH. The neurobiological basis of cognitive impairment in Parkinson's disease. Mov Disord 2014; 29:634-50. [PMID: 24757112 DOI: 10.1002/mds.25857] [Citation(s) in RCA: 240] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/08/2014] [Accepted: 02/13/2014] [Indexed: 12/13/2022] Open
Abstract
The recent formalization of clinical criteria for Parkinson's disease with dementia (PDD) codifies many studies on this topic, including those assessing biological correlates. These studies show that the emergence of PDD occurs on the background of severe dopamine deficits with, the main pathological drivers of cognitive decline being a synergistic effect between alpha-synuclein and Alzheimer's disease pathology. The presence of these pathologies correlates with a marked loss of limbic and cortically projecting dopamine, noradrenaline, serotonin, and acetylcholine neurons, although the exact timing of these relationships remains to be determined. Genetic factors, such as triplications in the α-synuclein gene, lead to a clear increased risk of PDD, whereas others, such as parkin mutations, are associated with a reduced risk of PDD. The very recent formalization of clinical criteria for PD with mild cognitive impairment (PD-MCI) allows only speculation on its biological and genetic bases. Critical assessment of animal models shows that chronic low-dose MPTP treatment in primates recapitulates PD-MCI over time, enhancing the current biological concept of PD-MCI as having enhanced dopamine deficiency in frontostriatal pathways as well as involvement of other neurotransmitter systems. Data from other animal models support multiple transmitter involvement in cognitive impairment in PD. Whereas dopamine dysfunction has been highlighted because of its obvious role in PD, the role of the other neurotransmitter systems, neurodegenerative pathologies, and genetic factors in PD-MCI remains to be fully elucidated.
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Affiliation(s)
- Glenda M Halliday
- Neuroscience Research Australia and the University of New South Wales, Sydney, Australia
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21
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Mild cognitive impairment in Parkinson's disease: How much testing is needed for correct diagnosis? ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.baga.2014.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Nie K, Zhang Y, Huang B, Wang L, Zhao J, Huang Z, Gan R, Wang L. Marked N-acetylaspartate and choline metabolite changes in Parkinson's disease patients with mild cognitive impairment. Parkinsonism Relat Disord 2013; 19:329-34. [DOI: 10.1016/j.parkreldis.2012.11.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 11/15/2012] [Accepted: 11/22/2012] [Indexed: 11/30/2022]
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23
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Jellinger KA. Neurobiology of cognitive impairment in Parkinson’s disease. Expert Rev Neurother 2012; 12:1451-1466. [DOI: 10.1586/ern.12.131] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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24
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Mild cognitive impairment in Parkinson disease: heterogenous mechanisms. J Neural Transm (Vienna) 2012; 120:157-67. [DOI: 10.1007/s00702-012-0771-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 01/29/2012] [Indexed: 10/28/2022]
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25
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Jellinger KA. Neuropathology of sporadic Parkinson's disease: evaluation and changes of concepts. Mov Disord 2011; 27:8-30. [PMID: 22081500 DOI: 10.1002/mds.23795] [Citation(s) in RCA: 311] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 04/19/2011] [Accepted: 04/21/2011] [Indexed: 12/30/2022] Open
Abstract
Parkinson's disease (PD), one of the most frequent neurodegenerative disorders, is no longer considered a complex motor disorder characterized by extrapyramidal symptoms, but a progressive multisystem or-more correctly-multiorgan disease with variegated neurological and nonmotor deficiencies. It is morphologically featured not only by the degeneration of the dopaminergic nigrostriatal system, responsible for the core motor deficits, but by multifocal involvement of the central, peripheral and autonomic nervous system and other organs associated with widespread occurrence of Lewy bodies and dystrophic Lewy neurites. This results from deposition of abnormal α-synuclein (αSyn), the major protein marker of PD, and other synucleinopathies. Recent research has improved both the clinical and neuropathological diagnostic criteria of PD; it has further provided insights into the development and staging of αSyn and Lewy pathologies and has been useful in understanding the pathogenesis of PD. However, many challenges remain, for example, the role of Lewy bodies and the neurobiology of axons in the course of neurodegeneration, the relation between αSyn, Lewy pathology, and clinical deficits, as well as the interaction between αSyn and other pathologic proteins. Although genetic and experimental models have contributed to exploring the causes, pathomechanisms, and treatment options of PD, there is still a lack of an optimal animal model, and the etiology of this devastating disease is far from being elucidated.
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Heterogenous mechanisms of mild cognitive impairment in Parkinson’s disease. J Neural Transm (Vienna) 2011; 119:381-2. [PMID: 21960008 DOI: 10.1007/s00702-011-0716-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 09/13/2011] [Indexed: 10/17/2022]
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Lee JE, Cho KH, Kim M, Sohn YH, Lee PH. The pattern of cortical atrophy in Parkinson's disease with mild cognitive impairment according to the timing of cognitive dysfunction. J Neurol 2011; 259:469-73. [PMID: 21818688 DOI: 10.1007/s00415-011-6203-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 07/22/2011] [Accepted: 07/24/2011] [Indexed: 10/18/2022]
Abstract
The density of Lewy bodies or the concurrent β-amyloid pathology would act as modulators in the relative timing of dementia during the course of Parkinson's disease. Depending on the temporal relationship between the onset of parkinsonism and that of cognitive impairment, patients with Parkinson's disease with mild cognitive impairment were divided into two groups of earlier (<1 year) and later (≥1 year) cognitive decline, and cortical atrophy patterns and correlation of gray matter and timing of cognitive decline were analyzed using voxel-based morphometry. The morphometric analysis showed that patients with earlier cognitive decline demonstrated greater cortical atrophy in the inferior parietal and orbitofrontal areas than did those with later cognitive decline. Additionally, the anatomical bases of the timing of their cognitive decline differed in terms of correlation patterns. These data suggest that the pathological burden in Parkinson's disease with mild cognitive impairment may be more severe in patients with earlier cognitive decline than in those with later cognitive decline, and that the neural basis corresponding to the timing of cognitive decline may differ in these patients.
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Affiliation(s)
- Ji E Lee
- Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, South Korea
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Macdonald PA, Monchi O. Differential effects of dopaminergic therapies on dorsal and ventral striatum in Parkinson's disease: implications for cognitive function. PARKINSONS DISEASE 2011; 2011:572743. [PMID: 21437185 PMCID: PMC3062097 DOI: 10.4061/2011/572743] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 01/07/2011] [Indexed: 11/20/2022]
Abstract
Cognitive abnormalities are a feature of Parkinson's disease (PD). Unlike motor symptoms that are clearly improved by dopaminergic therapy, the effect of dopamine replacement on cognition seems paradoxical. Some cognitive functions are improved whereas others are unaltered or even hindered. Our aim was to understand the effect of dopamine replacement therapy on various aspects of cognition. Whereas dorsal striatum receives dopamine input from the substantia nigra (SN), ventral striatum is innervated by dopamine-producing cells in the ventral tegmental area (VTA). In PD, degeneration of SN is substantially greater than cell loss in VTA and hence dopamine-deficiency is significantly greater in dorsal compared to ventral striatum. We suggest that dopamine supplementation improves functions mediated by dorsal striatum and impairs, or heightens to a pathological degree, operations ascribed to ventral striatum. We consider the extant literature in light of this principle. We also survey the effect of dopamine replacement on functional neuroimaging in PD relating the findings to this framework. This paper highlights the fact that currently, titration of therapy in PD is geared to optimizing dorsal striatum-mediated motor symptoms, at the expense of ventral striatum operations. Increased awareness of contrasting effects of dopamine replacement on dorsal versus ventral striatum functions will lead clinicians to survey a broader range of symptoms in determining optimal therapy, taking into account both those aspects of cognition that will be helped versus those that will be hindered by dopaminergic treatment.
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Affiliation(s)
- Penny A Macdonald
- Department of Neurology & Neurosurgery, McGill University, Montreal, QC, Canada
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Jellinger KA. Mild cognitive impairment in Parkinson’s disease: a critical update. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.10.80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Evaluation of: Aarsland D, Bronnick K, Williams-Gray C et al.: Mild cognitive impairment in Parkinson disease: a multicenter pooled analysis. Neurology 75, 1062–1069 (2010). A clinical analysis of 1346 patients with Parkinson’s disease (PD) from eight different cohorts, using standardized criteria and cognitive tests, revealed an incidence of mild cognitive impairment (MCI) in 25.8%. It affected various cognitive domains, most frequently memory (13.3%), visuospatial (11%) and attention-executive abilities (10.1%). MCI was classified as nonamnestic and amnestic single domain (11.2 and 8.9%, respectively), and amnestic and nonamnestic multiple domain (4.8 and 1.3%, respectively). The author comments on this clinical study of a well-characterized multicenter cohort showing that PD-MCI was associated with older age at disease onset, male gender, depression, more severe motor symptoms and advanced disease stage. The potential mechanisms underlying MCI in PD patients are compared with non-PD patients, and recent data on heterogeneous neuropathology in both PD-MCI and non-PD-MCI are discussed.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Kenyongasse 18, A-1070 Vienna, Austria
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Adler CH, Beach TG. Variability of diffuse plaques and amyloid angiopathy in Parkinson’s disease with mild cognitive impairment. Acta Neuropathol 2010. [DOI: 10.1007/s00401-010-0757-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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