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Xue QL, Buta B, Ma L, Ge M, Carlson M. Integrating Frailty and Cognitive Phenotypes: Why, How, Now What? CURRENT GERIATRICS REPORTS 2019; 8:97-106. [PMID: 31815092 PMCID: PMC6897328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW This review elucidates the concept of frailty in relationship to reserve and resilience, the relationships and shared pathophysiology between physical frailty and cognitive impairment, the theoretical underpinnings of three integrated phenotypes of physical and cognitive impairments, and the potential of incorporating biomarkers into phenotype refinement and validation. RECENT FINDINGS The fact that frailty and cognitive impairment are associated and often coexist in older adults has led to the popular view of expanding the definition of frailty to include cognitive impairment. However, there is great variability in approaches to and assumptions regarding the integrated phenotypes of physical frailty and cognitive impairment. SUMMARY The development of integrated frailty and cognitive phenotypes should explicate the types of frailty and cognitive impairment they intend to capture and prioritize the incorporation of biological theories that help determine shared and distinct pathways in the progression to physical and cognitive impairments.
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Affiliation(s)
- Qian-Li Xue
- Department of Medicine Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Brian Buta
- Department of Medicine Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Lina Ma
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Meiling Ge
- The Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, China
| | - Michelle Carlson
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Xue QL, Buta B, Ma L, Ge M, Carlson M. Integrating Frailty and Cognitive Phenotypes: Why, How, Now What? CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-0279-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Mazzeo A, Russo M, Di Bella G, Minutoli F, Stancanelli C, Gentile L, Baldari S, Carerj S, Toscano A, Vita G. Transthyretin-Related Familial Amyloid Polyneuropathy (TTR-FAP): A Single-Center Experience in Sicily, an Italian Endemic Area. J Neuromuscul Dis 2015; 2:S39-S48. [PMID: 27858761 PMCID: PMC5271421 DOI: 10.3233/jnd-150091] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Familial amyloid polyneuropathy related to transthyretin gene (TTR-FAP) is a life-threatening disease transmitted as an autosomal dominant trait. Val30Met mutation accounts for the majority of the patients with large endemic foci especially in Portugal, Sweden and Japan. However, more than one hundred other mutations have been described worldwide. A great phenotypic variability among patients with late- and early-onset has been reported. Objective: To present a detailed report of TTR-FAP patients diagnosed in our tertiary neuromuscular center, in a 20-year period. Methods: Clinical informations were gathered through the database of our center. Results: The study involved 76 individuals carrying a TTR-FAP mutation. Three phenotypes were identified, each corresponding to a different TTR variant, homogeneous within and heterogeneous between each other: i) Glu89Gln mutation, characterised by 5th – 6th decade onset, neuropathy as presenting symptoms, early heart dysfunction, cardiomyopathy as major cause of mortality followed by dysautonomia and cachexia; ii) Phe64Leu mutation, marked by familiarity reported in one-half of cases, late onset, severe peripheral neuropathy, moderate dysautonomia and mild cardiomyopathy, death for wasting syndrome; iii) Thr49Ala mutation, distinguished by onset in the 5th decade, autonomic disturbances as inaugural symptoms which may remain isolated for many years, moderate polyneuropathy, cachexia as major cause of mortality followed by cardiomyopathy. Conclusions: This survey highlighted a prevalence of 8.8/1,000,000 in Sicily Island. Good knowledge of the natural history of the disease according to different TTR mutations allow clinicians to optimise multiprofessional care for patients and to offer carriers a personalized follow-up to reveal first signs of the disease.
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Affiliation(s)
- Anna Mazzeo
- Department of Neurosciences, University of Messina, Messina, Italy
| | - Massimo Russo
- NEMO SUD Center for Neuromuscular Disorders, Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Fabio Minutoli
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Claudia Stancanelli
- Department of Neurosciences, University of Messina, Messina, Italy.,Biomedical Department of Internal and Specialistic Medicine, University of Palermo, Palermo, Italy
| | - Luca Gentile
- Department of Neurosciences, University of Messina, Messina, Italy
| | - Sergio Baldari
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Toscano
- Department of Neurosciences, University of Messina, Messina, Italy
| | - Giuseppe Vita
- Department of Neurosciences, University of Messina, Messina, Italy.,NEMO SUD Center for Neuromuscular Disorders, Messina, Italy
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Boles RG, Zaki EA, Kerr JR, Das K, Biswas S, Gardner A. Increased prevalence of two mitochondrial DNA polymorphisms in functional disease: Are we describing different parts of an energy-depleted elephant? Mitochondrion 2015; 23:1-6. [PMID: 25934187 DOI: 10.1016/j.mito.2015.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/18/2015] [Accepted: 04/22/2015] [Indexed: 12/19/2022]
Abstract
About 20% of the population suffers from "functional syndromes". Since these syndromes overlap greatly in terms of co-morbidity, pathophysiology (including aberrant autonomic activity) and treatment responses, common predisposing genetic factors have been postulated. We had previously showed that two common mitochondrial DNA (mtDNA) polymorphisms at positions 16519 and 3010 are statistically associated with the functional syndromes of migraine, cyclic vomiting syndrome and non-specific abdominal pain. Herein, among individuals with mtDNA haplogroup H (HgH), the presence of these two mtDNA polymorphisms were ascertained in additional functional syndromes: chronic fatigue syndrome, complex regional pain syndrome, sudden infant death syndrome, and major depressive disorder. Polymorphic prevalence rates were compared between disease and control groups, and within each disease group in participants with and without specific clinical findings. In all four conditions, one or both of the polymorphisms was significantly associated with the respective condition and/or co-morbid functional symptomatology. Thus, we conclude that these two mtDNA polymorphisms likely modify risk for the development of multiple functional syndromes, likely constituting a proportion of the postulated common genetic factor, at least among individuals with HgH. Pathophysiology likely involves broad effects on the autonomic nervous system.
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Affiliation(s)
- Richard G Boles
- Division of Medical Genetics and the Saban Research Institute, Children's Hospital Los Angeles, CA USA; Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, CA USA.
| | - Essam A Zaki
- Division of Medical Genetics and the Saban Research Institute, Children's Hospital Los Angeles, CA USA
| | - Jonathan R Kerr
- Division of Clinical Sciences, St. George's University of London, Cranmer Terrace, London United Kingdom
| | - Kingshuk Das
- Division of Medical Genetics and the Saban Research Institute, Children's Hospital Los Angeles, CA USA
| | - Sawona Biswas
- Division of Medical Genetics and the Saban Research Institute, Children's Hospital Los Angeles, CA USA
| | - Ann Gardner
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm Sweden
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Finsterer J, Kothari S. Cardiac manifestations of primary mitochondrial disorders. Int J Cardiol 2014; 177:754-63. [PMID: 25465824 DOI: 10.1016/j.ijcard.2014.11.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/23/2014] [Accepted: 11/03/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES One of the most frequently affected organs in mitochondrial disorders (MIDs), defined as hereditary diseases due to affection of the mitochondrial energy metabolism, is the heart. Cardiac involvement (CI) in MIDs has therapeutic and prognostic implications. This review aims at summarizing and discussing the various cardiac manifestations in MIDs. METHODS Data for this review were identified by searches of MEDLINE, Current Contents, and PubMed using appropriate search terms. RESULTS CI in MIDs may be classified according to various different criteria. In the present review cardiac abnormalities in MIDs are discussed according to their frequency with which they occur. CI in MIDs includes cardiomyopathy, arrhythmias, heart failure, pulmonary hypertension, dilation of the aortic root, pericardial effusion, coronary heart disease, autonomous nervous system dysfunction, congenital heart defects, or sudden cardiac death. The most frequent among the cardiomyopathies is hypertrophic cardiomyopathy, followed by dilated cardiomyopathy, and noncompaction. CONCLUSIONS CI in MID is more variable and prevalent than previously thought. All tissues of the heart may be variably affected. The most frequently affected tissue is the myocardium. MIDs should be included in the differential diagnoses of cardiac disease.
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Autonomic involvement in subacute and chronic immune-mediated neuropathies. Autoimmune Dis 2013; 2013:549465. [PMID: 23853716 PMCID: PMC3703364 DOI: 10.1155/2013/549465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/28/2013] [Indexed: 12/03/2022] Open
Abstract
Autonomic function can be impaired in many disorders in which sympathetic, parasympathetic, and enteric arms of the autonomic nervous system are affected. Signs and symptoms of autonomic involvement are related to impairment of cardiovascular, gastrointestinal, urogenital, thermoregulatory, sudomotor, and pupillomotor autonomic functions. Availability of noninvasive, sensitive, and reproducible tests can help to recognize these disorders and to better understand specific mechanisms of some, potentially treatable, immune-mediated autonomic neuropathies. This paper describes autonomic involvement in immune-mediated neuropathies with a subacute or chronic course.
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Abstract
The autonomic nervous system is involved and influenced in patients with epilepsy and mitochondrial diseases in a variety of complex, often multifaceted, mechanisms. Autonomic dysfunction often remains unrecognized due to a lack of attention and awareness under the prominence of other disease symptoms. Recognition of the diverse autonomic manifestations of epilepsy and mitochondrial disease would enhance early diagnosis and appropriate management, ultimately improving quality the of life and reducing morbidity and mortality in the affected patients. In this chapter, we discuss autonomic nervous system dysfunction in children with epilepsy (Part I) and mitochondrial diseases (Part II).
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Affiliation(s)
- Sumit Parikh
- Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Russo M, Mazzeo A, Stancanelli C, Di Leo R, Gentile L, Di Bella G, Minutoli F, Baldari S, Vita G. Transthyretin-related familial amyloidotic polyneuropathy: description of a cohort of patients with Leu64 mutation and late onset. J Peripher Nerv Syst 2012; 17:385-90. [DOI: 10.1111/j.1529-8027.2012.00436.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | | | | | | | | | - Fabio Minutoli
- Department of Radiological Sciences, Nuclear Medicine Unit; University of Messina; Messina; Italy
| | - Sergio Baldari
- Department of Radiological Sciences, Nuclear Medicine Unit; University of Messina; Messina; Italy
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Parsons T, Weimer L, Engelstad K, Linker A, Battista V, Wei Y, Hirano M, Dimauro S, De Vivo DC, Kaufmann P. Autonomic symptoms in carriers of the m.3243A>G mitochondrial DNA mutation. ACTA ACUST UNITED AC 2010; 67:976-9. [PMID: 20697048 DOI: 10.1001/archneurol.2010.174] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The m.3243A>G mutation can cause multisystem medical problems and can affect the autonomic nervous system. OBJECTIVE To study the frequency and spectrum of autonomic symptoms associated with the m.3243A>G mitochondrial DNA point mutation. Design, Setting, and Patients We studied a cohort of 88 matrilineal relatives from 40 families, including 35 fully symptomatic patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS), 53 carrier relatives, and 16 controls using a questionnaire based on existing standard instruments for the evaluation of autonomic dysfunction. We compared the questionnaire with an expert evaluation. We compared data among the 3 groups using the Mantel-Haenszel chi(2) test to determine the statistical significance of differences between groups. RESULTS Mutation carriers frequently had symptoms of autonomic dysfunction, specifically gastrointestinal and orthostatic intolerance. CONCLUSIONS Carriers of the m.3243A>G mutation have frequent autonomic symptoms. The m.3243A>G mutation should be considered as an etiological factor in patients with autonomic dysfunction and a medical or family history suggestive of mitochondrial disease. Because some autonomic symptoms are treatable, early detection and proactive management may mitigate the burden of morbidity.
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Affiliation(s)
- Timothy Parsons
- Department of Neurology, Columbia University, 710 W 168th St, New York, NY 10032, USA
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