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Sinai A, Nassar M, Shornikov L, Constantinescu M, Zaaroor M, Schlesinger I. Focused Ultrasound Thalamotomy for Tremor Relief in Atypical Parkisnsonism. PARKINSON'S DISEASE 2024; 2024:6643510. [PMID: 38476865 PMCID: PMC10932618 DOI: 10.1155/2024/6643510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 12/04/2023] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
Background Magnetic resonance imaging (MRI)-guided focused ultrasound (FUS) VIM-thalamotomy has established efficacy and safety in tremor relief in patients with essential tremor and Parkinson's disease. The efficacy and safety in patients with atypical parkinsonism have not been reported. Objective To report on the efficacy and safety of FUS VIM-thalamotomy in 8 patients with parkinsonism, multiple system atrophy-Parkinsonian type (MSA-P) (n = 5), and dementia with Lewy bodies (DLB) (n = 3). Methods Tremor was assessed in the treated hemibody using the Clinical Rating Scale for Tremor (CRST). The motor Unified MSA Rating Scale (UMSAR) was used in the MSA-P and motor sections of the Unified Parkinson's Disease Rating Scale (UPDRS-III) in DLB patients. Cognition was measured using the Montreal Cognitive Assessment (MoCA). Results In MSA-P and DLB patients, there was immediate tremor relief. CRST scores measured on the treated side improved compared to baseline. During the follow-up of up to 1 year tremor reduction persisted. The change in CRST scores at different time points did not reach statistical significance, probably due to the small sample size. Adverse events were transient and resolved within a year. Conclusions In our experience, FUS VIM-thalamotomy was effective in patients with MSA-P and DLB. Larger, controlled studies are needed to verify our preliminary observations.
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Affiliation(s)
- Alon Sinai
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
| | - Maria Nassar
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Lev Shornikov
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | | | - Menashe Zaaroor
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Ilana Schlesinger
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
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Watts KE, Storr NJ, Barr PG, Rajkumar AP. Systematic review of pharmacological interventions for people with Lewy body dementia. Aging Ment Health 2023; 27:203-216. [PMID: 35109724 DOI: 10.1080/13607863.2022.2032601] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Lewy body dementia (LBD) is the second most common neurodegenerative dementia, and it causes earlier mortality and more morbidity than Alzheimer's disease. Reviewing current evidence on its pharmacological management is essential for developing evidence-based clinical guidelines, and for improving the quality of its clinical care. Hence, we systematically reviewed all studies that investigated the efficacy of any medication for managing various symptoms of LBD. METHOD We identified eligible studies by searching 15 databases comprehensively. We completed quality assessment, extracted relevant data, and performed GRADE assessment of available evidence. We conducted meta-analyses when appropriate (PROSPERO:CRD42020182166). RESULTS We screened 18,884 papers and included 135 studies. Our meta-analyses confirmed level-1 evidence for Donepezil's efficacy of managing cognitive symptoms of dementia with Lewy bodies (DLB) (SMD = 0.63; p < 0.001) and Parkinson's Disease Dementia (PDD) (SMD = 0.43; p < 0.01), and managing hallucinations in DLB (SMD=-0.52; p = 0.02). Rivastigmine and Memantine have level-2 evidence for managing cognitive and neuropsychiatric symptoms of DLB. Olanzapine and Yokukansan have similar evidence for managing DLB neuropsychiatric symptoms. Level-2 evidence support the efficacy of Rivastigmine and Galantamine for managing cognitive and neuropsychiatric symptoms of PDD. CONCLUSION We list evidence-based recommendations for the pharmacological management of DLB and PDD, and propose specific clinical guidelines for improving their clinical management. UNLABELLED Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2022.2032601 .
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Affiliation(s)
- Katrina E Watts
- Institute of Mental Health, Mental Health and Clinical Neurosciences academic unit, University of Nottingham, Nottingham, UK
| | - Nicholas J Storr
- Institute of Mental Health, Mental Health and Clinical Neurosciences academic unit, University of Nottingham, Nottingham, UK
| | - Phoebe G Barr
- Institute of Mental Health, Mental Health and Clinical Neurosciences academic unit, University of Nottingham, Nottingham, UK
| | - Anto P Rajkumar
- Institute of Mental Health, Mental Health and Clinical Neurosciences academic unit, University of Nottingham, Nottingham, UK.,Mental Health Services of Older People, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
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Maneval J, Woods JK, Feany MB, Miller MB, Silbersweig DA, Gale SA, Daffner KR, McGinnis SM. Case Study 3: A 58-Year-Old Woman Referred for Evaluation of Suspected Alzheimer Dementia. J Neuropsychiatry Clin Neurosci 2022; 34:307-315. [PMID: 36239480 PMCID: PMC9823288 DOI: 10.1176/appi.neuropsych.20220113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jeffrey Maneval
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - Jared K. Woods
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - Mel B. Feany
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - Michael B. Miller
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - David A. Silbersweig
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - Seth A. Gale
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - Kirk R. Daffner
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
| | - Scott M. McGinnis
- Department of Neurology (Maneval, Silbersweig, Gale, Daffner, McGinnis) and Department of Psychiatry (Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Woods, Feany, Miller), Brigham and Women’s Hospital, Harvard Medical School, Boston; Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (McGinnis)
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Chu CS, Yang FC, Tseng PT, Stubbs B, Dag A, Carvalho AF, Thompson T, Tu YK, Yeh TC, Li DJ, Tsai CK, Chen TY, Ikeda M, Liang CS, Su KP. Treatment Efficacy and Acceptabilityof Pharmacotherapies for Dementia with Lewy Bodies: A Systematic Review and Network Meta-Analysis. Arch Gerontol Geriatr 2021; 96:104474. [PMID: 34256210 DOI: 10.1016/j.archger.2021.104474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/27/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We investigated the efficacy and acceptability of pharmacotherapy for dementia with Lewy bodies (DLB) while simultaneously considering the neuropsychiatric symptoms (NPS), cognitive function, motor symptoms, and acceptability. METHODS Electronic databases were searched from inception through June 5, 2019, for randomized controlled trials (RCTs) and open-label trials (OLTs) in patients with DLB. We performed a pairwise conventional meta-analysis (PWMA) and network meta-analysis (NMA) within a frequentist framework. The main outcomes were mean change scores in NPS, general cognition, motor symptoms and acceptability. The effect sizes and odds ratios with 95% confidence intervals (CIs) were calculated. This study was registered with PROSPERO (CRD42018096996). RESULTS In total, we included 29 studies (9 RCTs and 20 OLTs). In the NMA with 9 RCTs, both high- (mean difference [MD] 2.00, 95% CIs, 0.69 to 3.31) and low-dose (1.86, 0.58 to 3.15) donepezil were associated with a greater cognitive improvement than placebo. High-dose zonisamide was associated with greater motor symptom improvement ( -4.10, -7.03 to -1.17]). No medications reached statistical significance regarding improving neuropsychiatric symptoms or developing intolerable adverse effects as compared to placebo. In the second NMA, with 29 studies as an exploratory analysis, aripiprazole and yokukansan may be effective for neuropsychiatric symptoms, while levodopa may be associated with cognitive impairment. CONCLUSIONS We report the most comprehensive evidence for the selection of pharmacotherapy for treating different clusters of DLB-related symptoms. Due to the limited availability of RCTs on DLB, more well-conducted RCTs are needed for MMA to warrant clinical efficacy in the future.
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Affiliation(s)
- Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Non-invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ping-Tao Tseng
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry, King's College London, UK
| | - Aarsland Dag
- Centre for Age-related Medicine, Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
| | - Trevor Thompson
- School of Human Sciences, University of Greenwich, London, UK
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Dian-Jeng Li
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Chia-Kuang Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Kuan-Pin Su
- Institute of Psychiatry, King's College London, UK; Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan.
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Taylor JP, McKeith IG, Burn DJ, Boeve BF, Weintraub D, Bamford C, Allan LM, Thomas AJ, O'Brien JT. New evidence on the management of Lewy body dementia. Lancet Neurol 2020; 19:157-169. [PMID: 31519472 PMCID: PMC7017451 DOI: 10.1016/s1474-4422(19)30153-x] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 03/09/2019] [Accepted: 03/13/2019] [Indexed: 02/06/2023]
Abstract
Dementia with Lewy bodies and Parkinson's disease dementia, jointly known as Lewy body dementia, are common neurodegenerative conditions. Patients with Lewy body dementia present with a wide range of cognitive, neuropsychiatric, sleep, motor, and autonomic symptoms. Presentation varies between patients and can vary over time within an individual. Treatments can address one symptom but worsen another, which makes disease management difficult. Symptoms are often managed in isolation and by different specialists, which makes high-quality care difficult to accomplish. Clinical trials and meta-analyses now provide an evidence base for the treatment of cognitive, neuropsychiatric, and motor symptoms in patients with Lewy body dementia. Furthermore, consensus opinion from experts supports the application of treatments for related conditions, such as Parkinson's disease, for the management of common symptoms (eg, autonomic dysfunction) in patients with Lewy body dementia. However, evidence gaps remain and future clinical trials need to focus on the treatment of symptoms specific to patients with Lewy body dementia.
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Affiliation(s)
- John-Paul Taylor
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
| | - Ian G McKeith
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - David J Burn
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Brad F Boeve
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Daniel Weintraub
- Department of Psychiatry and Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; Parkinson's Disease and Mental Illness Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Claire Bamford
- Institute of Health and Society, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Alan J Thomas
- Institute of Neuroscience, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
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Pal P, Mailankody P, George L, Naduthota R, Saini J, Thennarasu K, Yadav R. Re-emergent tremor in patients with Parkinson’s disease: an imaging study. ANNALS OF MOVEMENT DISORDERS 2020. [DOI: 10.4103/aomd.aomd_36_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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8
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Palermo G, Ceravolo R, Bonuccelli U. Advances in the pharmacotherapeutic management of dementia with Lewy bodies. Expert Opin Pharmacother 2018; 19:1643-1653. [PMID: 30212224 DOI: 10.1080/14656566.2018.1519548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Dementia with Lewy bodies (DLB) is the second most common type of dementia in people over 65 years of age. Given the complex clinical phenotype, the management of DLB may be challenging, especially considering that there is limited evidence about specific interventions, and there are currently no Food and Drug Administration (FDA)/European Medicines Agency (EMA)-approved medications. AREAS COVERED This article provides an overview of the current pharmacotherapy in DLB and gives review to the most recent drug candidates in clinical trials. EXPERT OPINION Commonly prescribed drugs are primarily aimed at treating the most troublesome clinical features of DLB. Although these medications provide some benefit to symptoms, there is, unfortunately, a lack of DLB-specific evidence on effective treatments and their off-label use. Indeed, most treatments used come from clinical trials on patients with Alzheimer's disease or Parkinson's disease. Thus, there is an urgent need for randomized clinical trials in DLB patients. Despite several challenges, potential new drugs are in ongoing clinical trials; furthermore, as our understanding of molecular and cellular mechanisms underlying DLB broaden, it is likely that we will identify novel drug targets for the development of better and more effective symptomatic products and disease-modifying therapies.
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Affiliation(s)
- Giovanni Palermo
- a Department of Clinical and Experimental Medicine , Unit of Neurology, University of Pisa , Pisa , Italy
| | - Roberto Ceravolo
- a Department of Clinical and Experimental Medicine , Unit of Neurology, University of Pisa , Pisa , Italy
| | - Ubaldo Bonuccelli
- a Department of Clinical and Experimental Medicine , Unit of Neurology, University of Pisa , Pisa , Italy
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Capouch SD, Farlow MR, Brosch JR. A Review of Dementia with Lewy Bodies' Impact, Diagnostic Criteria and Treatment. Neurol Ther 2018; 7:249-263. [PMID: 29987534 PMCID: PMC6283803 DOI: 10.1007/s40120-018-0104-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Indexed: 12/16/2022] Open
Abstract
Dementia with Lewy bodies is one of the most common causes of dementia. It is not as common as Alzheimer's disease; the general public's awareness of the disease is poor in comparison. Its effects on caregivers and patients alike are not well known to the general population. There are currently no FDA-approved medications specifically for the treatment of DLB. Many of the medications that are approved for Alzheimer's disease are widely used in the treatment of DLB with varying degrees of success. Treatment of DLB is life long and requires a dedicated team of physicians and caregivers to minimize the degree of morbidity and mortality experienced by the patients suffering from the disease as it progresses.
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Affiliation(s)
- Samuel D Capouch
- Department of Neurology, Indiana University School of Medicine, 355 W 16th St #4700, Indianapolis, IN, 46202, USA
| | - Martin R Farlow
- Department of Neurology, Indiana University School of Medicine, 355 W 16th St #4700, Indianapolis, IN, 46202, USA
| | - Jared R Brosch
- Department of Neurology, Indiana University School of Medicine, 355 W 16th St #4700, Indianapolis, IN, 46202, USA.
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Abstract
Dementia syndromes associated with Lewy bodies are subdivided into dementia with Lewy bodies (DLB), an underdiagnosed cause of dementia in the elderly, and Parkinson disease with dementia (PDD), cognitive impairment appearing in people diagnosed with Parkinson disease. Their neuropathologic substrates are the widespread distribution of aggregates of the protein α-synuclein in neurons in cortical brain regions, accompanied by variable Alzheimer pathology. Clinical features of DLB and PDD include distinctive changes in cognition, behavior, movement, sleep, and autonomic function. Diagnostic criteria for DLB and PDD incorporate these features. Current treatment options for DLB and PDD are symptomatic.
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Affiliation(s)
- Douglas Galasko
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0948, USA.
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Mailankody P, Thennarasu K, Nagaraju BC, Yadav R, Pal PK. Re-emergent tremor in Parkinson's disease: A clinical and electromyographic study. J Neurol Sci 2016; 366:33-36. [PMID: 27288772 DOI: 10.1016/j.jns.2016.04.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 04/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Re-emergent tremor (ReT) in Parkinson's disease (PD) is the tremor that re-emerges after a variable period of latency while maintaining posture. The phenomenology and electrophysiological aspects of ReT have not been well characterized. The aims of this study were to characterize ReT clinically and electrophysiologically. METHODS Sixty three patients with tremor dominant PD were recruited and subjected to clinical and electrophysiological evaluations. Group 1 consisted of 26 patients with rest tremor (RT) and ReT and group 2 consisted of 37 patients with RT and postural tremor (PT). The presence of silent period of ReT was determined clinically and confirmed electrophysiologically. RESULTS The duration of illness was significantly shorter in patients with ReT as compared to patients without ReT (5.2±4.4years vs 7.4±4.5years, p=0.03). ReT was similar to RT in terms of both frequency (4.8±0.7Hz vs 4.7±0.6Hz, p=0.1) and pattern of contraction. The frequency of RT was not significantly different in the 2 groups (p=0.5). The mean duration of silent period was 8.1±8.7s. CONCLUSIONS A significantly shorter duration of illness was found in patients with ReT as compared to patients without ReT. ReT is similar to RT in terms of frequency and pattern of contraction. However, the presence of silent period may imply additional pathophysiological mechanisms.
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Affiliation(s)
- Pooja Mailankody
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - K Thennarasu
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India; Department of Biostatistics, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - B C Nagaraju
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Hosur Road, Bangalore 560029, Karnataka, India.
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Abstract
Patients who have dementia with Lewy bodies (DLB) and undergo surgery may develop aggravated postoperative cognitive dysfunction or postoperative delirium. Many patients with DLB respond poorly to surgery and anesthesia, and their conditions may worsen if they have other medical complications along with dementia. They may also face high risk of prolonged hospital stay, increased medical problems and/or mortality, causing significant physical, psychosocial, and financial burdens on individuals, family members, and society. Anesthesia, pain medications, old age, and surgery-related stresses are usually held responsible for the complications; however, the exact causes are still not fully understood. Literature on surgery-related complications for patients with DLB appears to be inadequate, and hence the topic merits detailed and systematic research. This article reviews postoperative complications and various surgery-related risk factors for DLB in light of other dementias such as Alzheimer's disease, as their neuropathologic features overlap with those of DLB.
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Affiliation(s)
- Farzana Pervin
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Carolyn Edwards
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Carol F Lippa
- Drexel University College of Medicine, Philadelphia, PA, USA
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Franciotti R, Delli Pizzi S, Perfetti B, Tartaro A, Bonanni L, Thomas A, Weis L, Biundo R, Antonini A, Onofrj M. Default mode network links to visual hallucinations: A comparison between Parkinson's disease and multiple system atrophy. Mov Disord 2015; 30:1237-47. [PMID: 26094856 DOI: 10.1002/mds.26285] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Studying default mode network activity or connectivity in different parkinsonisms, with or without visual hallucinations, could highlight its roles in clinical phenotypes' expression. Multiple system atrophy is the archetype of parkinsonism without visual hallucinations, variably appearing instead in Parkinson's disease (PD). We aimed to evaluate default mode network functions in multiple system atrophy in comparison with PD. METHODS Functional magnetic resonance imaging evaluated default mode network activity and connectivity in 15 multiple system atrophy patients, 15 healthy controls, 15 early PD patients matched for disease duration, 30 severe PD patients (15 with and 15 without visual hallucinations), matched with multiple system atrophy for disease severity. Cortical thickness and neuropsychological evaluations were also performed. RESULTS Multiple system atrophy had reduced default mode network activity compared with controls and PD with hallucinations, and no differences with PD (early or severe) without hallucinations. In PD with visual hallucinations, activity and connectivity was preserved compared with controls and higher than in other groups. In early PD, connectivity was lower than in controls but higher than in multiple system atrophy and severe PD without hallucinations. Cortical thickness was reduced in severe PD, with and without hallucinations, and correlated only with disease duration. Higher anxiety scores were found in patients without hallucinations. CONCLUSIONS Default mode network activity and connectivity was higher in PD with visual hallucinations and reduced in multiple system atrophy and PD without visual hallucinations. Cortical thickness comparisons suggest that functional, rather than structural, changes underlie the activity and connectivity differences.
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Affiliation(s)
- Raffaella Franciotti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University and Aging Research Centre, Ce.S.I., "G. d'Annunzio" University Foundation, Chieti, Italy.,ITAB, "G. d'Annunzio" University Foundation, Chieti, Italy
| | - Stefano Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University and Aging Research Centre, Ce.S.I., "G. d'Annunzio" University Foundation, Chieti, Italy.,ITAB, "G. d'Annunzio" University Foundation, Chieti, Italy
| | - Bernardo Perfetti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University and Aging Research Centre, Ce.S.I., "G. d'Annunzio" University Foundation, Chieti, Italy
| | - Armando Tartaro
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University and Aging Research Centre, Ce.S.I., "G. d'Annunzio" University Foundation, Chieti, Italy.,ITAB, "G. d'Annunzio" University Foundation, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University and Aging Research Centre, Ce.S.I., "G. d'Annunzio" University Foundation, Chieti, Italy
| | - Astrid Thomas
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University and Aging Research Centre, Ce.S.I., "G. d'Annunzio" University Foundation, Chieti, Italy
| | - Luca Weis
- Department for Parkinson's Disease, "Fondazione Ospedale San Camillo", I.R.C.C.S, Venice, Italy
| | - Roberta Biundo
- Department for Parkinson's Disease, "Fondazione Ospedale San Camillo", I.R.C.C.S, Venice, Italy
| | - Angelo Antonini
- Department for Parkinson's Disease, "Fondazione Ospedale San Camillo", I.R.C.C.S, Venice, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University and Aging Research Centre, Ce.S.I., "G. d'Annunzio" University Foundation, Chieti, Italy
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14
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Petrova M, Mehrabian-Spasova S, Aarsland D, Raycheva M, Traykov L. Clinical and Neuropsychological Differences between Mild Parkinson's Disease Dementia and Dementia with Lewy Bodies. Dement Geriatr Cogn Dis Extra 2015; 5:212-20. [PMID: 26195977 PMCID: PMC4483490 DOI: 10.1159/000375363] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The specific profile of dementia in Parkinson's disease (PDD) and dementia with Lewy bodies (DLB) in the earliest stages of dementia is still unclear and subject of considerable controversy. METHODS We investigated 27 PDD patients and 24 DLB patients with parkinsonism in the early stage of dementia, i.e. with a Mini-Mental State Examination score of ≥24. RESULTS Compared to PDD, patients with DLB demonstrated significantly lower scores when testing attention and executive functions [modified card sorting test (p < 0.001) and digit span backward (p < 0.02)], as well as when testing constructive abilities [copy of complex designs (p = 0.001) and pentagon (p < 0.001)]. Using logistic regression analysis, diagnosis was predicted from the cognitive profile, with an overall accuracy of 88.2%. In addition, PDD patients showed a significantly higher Unified Parkinson's Disease Rating Scale (UPDRS) motor subscore (p < 0.001) as well as higher UPDRS motor item scores [tremor at rest (p = 0.01) and bradykinesia (p = 0.001)]. CONCLUSIONS The cognitive profile in PDD differs from that in DLB in the early stage of dementia, with worse performance on tests of attention and executive functions and constructive abilities in DLB compared to PDD patients. In contrast, motor symptoms are more severe in PDD than in DLB.
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Affiliation(s)
- Mariya Petrova
- Department of Neurology, University Hospital ‘Alexandrovska’, Sofia, Bulgaria
| | | | - Dag Aarsland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Margarita Raycheva
- Department of Neurology, University Hospital ‘Alexandrovska’, Sofia, Bulgaria
| | - Latchezar Traykov
- Department of Neurology, University Hospital ‘Alexandrovska’, Sofia, Bulgaria
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15
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D'Amico MC, Borrelli I, Zhuzhuni H, D'Amico A, Di Giacomo R, Mancinelli L, di Tommaso V, Di Muzio A, Onofrj M. Holmes-Like Tremor in Ataxia With Oculomotor Apraxia Type 2. Mov Disord Clin Pract 2014; 1:261-262. [DOI: 10.1002/mdc3.12070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 05/12/2014] [Accepted: 05/25/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Maria Chiara D'Amico
- Department of Neuroscience and Imaging; University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
| | - Iole Borrelli
- Neurology Clinic; “SS. Annunziata” Hospital; Chieti Italy
| | - Holta Zhuzhuni
- Neurology Clinic; “SS. Annunziata” Hospital; Chieti Italy
| | | | | | | | | | | | - Marco Onofrj
- Department of Neuroscience and Imaging; University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
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16
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Bonanni L, Perfetti B, Bifolchetti S, Taylor JP, Franciotti R, Parnetti L, Thomas A, Onofrj M. Quantitative electroencephalogram utility in predicting conversion of mild cognitive impairment to dementia with Lewy bodies. Neurobiol Aging 2014; 36:434-45. [PMID: 25129239 PMCID: PMC4270449 DOI: 10.1016/j.neurobiolaging.2014.07.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/19/2014] [Accepted: 07/08/2014] [Indexed: 11/25/2022]
Abstract
Mild cognitive impairment (MCI) as a precursor of dementia with Lewy bodies (DLB) is the focus of recent research, trying to explore the early mechanisms and possible biomarkers of DLB. Quantitative electroencephalogram (QEEG) methods are able to differentiate early DLB from Alzheimer's disease (AD). The aim of the present study was to assess whether QEEG abnormalities, characterized by dominant frequency <8 Hz and dominant frequency variability >1.5 Hz, typical of early DLB, are already present at the stage of MCI and to evaluate whether EEG abnormalities can predict the development of DLB. Forty-seven MCI subjects were followed for 3 years. EEG recordings were obtained at admission and at the end of the study. At the end of follow-up, 20 subjects had developed probable DLB (MCI-DLB), 14 had probable AD (MCI-AD), 8 did not convert to dementia, 5 developed a non-AD/DLB dementia. One hundred percent of MCI-DLB showed EEG abnormalities at admission. Ninety three percent of MCI-AD maintained a normal EEG throughout the study. QEEG may represent a powerful tool to predict the progression from MCI to DLB with a sensitivity and specificity close to 100%. We studied in mild cognitive impairment (MCI) subjects the predictive value of electroencephalogram (EEG) alterations for the development of dementia with Lewy bodies (DLB). One hundred percent of MCI subjects converted to DLB already had EEG alterations typical of DLB (dominant frequency <8 Hz and dominant frequency variability ≥1.5 Hz) at admission to the study. Quantitative EEG may represent a powerful tool to predict the progression from MCI to DLB.
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Affiliation(s)
- Laura Bonanni
- Department of Neuroscience and Imaging, G. d'Annunzio University, Chieti, Italy; Aging Research Centre, Ce.S.I., G. d'Annunzio University Foundation, Chieti, Italy.
| | - Bernardo Perfetti
- Department of Neuroscience and Imaging, G. d'Annunzio University, Chieti, Italy; Aging Research Centre, Ce.S.I., G. d'Annunzio University Foundation, Chieti, Italy
| | - Stefania Bifolchetti
- Department of Neuroscience and Imaging, G. d'Annunzio University, Chieti, Italy; Aging Research Centre, Ce.S.I., G. d'Annunzio University Foundation, Chieti, Italy
| | - John-Paul Taylor
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Raffaella Franciotti
- Department of Neuroscience and Imaging, G. d'Annunzio University, Chieti, Italy; Institute for Advanced Biomedical Technologies (ITAB), G. d'Annunzio University Foundation, Chieti, Italy
| | - Lucilla Parnetti
- Center for Memory Disturbances and Alzheimer's Center, Section of Neurology, University of Perugia, Perugia, Italy
| | - Astrid Thomas
- Department of Neuroscience and Imaging, G. d'Annunzio University, Chieti, Italy; Aging Research Centre, Ce.S.I., G. d'Annunzio University Foundation, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience and Imaging, G. d'Annunzio University, Chieti, Italy; Aging Research Centre, Ce.S.I., G. d'Annunzio University Foundation, Chieti, Italy
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17
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Bonanni L, Onofrj M, Valente EM, Manzoli L, De Angelis MV, Capasso M, Thomas A. Recurrent and fatal akinetic crisis in genetic-mitochondrial parkinsonisms. Eur J Neurol 2014; 21:1242-6. [PMID: 24471704 DOI: 10.1111/ene.12364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/17/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Akinetic crisis (AC) is the most severe and possibly lethal complication of parkinsonism. It occurs with an incidence of 3‰ Parkinson's disease patients per year, but it is not known whether genetically determined parkinsonism is more or less susceptible to this complication. METHODS In a cohort of 756 parkinsonian patients the incidence and outcome of AC was prospectively assessed. A total of 142 of the parkinsonian patients were tested for genetic mutations because of familial parkinsonism, and 20 patients resulted positive: in four the mutation definitely involved mitochondrial functions (POLG1, PINK1), two presented with LRRK2 mutation, nine presented with GBA mutation and five presented with Park 4 different mutations. RESULTS Akinetic crisis occurred in 30 patients for an incidence of 2.8‰ persons/year and was lethal in seven (23%), not dissimilarly from known incidences of this complication. Yet six of 30 patients were carriers of genetic mutations, one GBA, one LRRK2, one POLG1 and three PINK1. In POLG1 and PINK1 carriers, the syndrome was recurrent and was fatal in three. Incidence of AC was 3.0‰ in familiar parkinsonism, 21.2‰ in genetic parkinsonisms. CONCLUSIONS Our preliminary findings suggest that the incidence of AC is remarkably increased in carriers of these genetic mutations.
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Affiliation(s)
- L Bonanni
- Neurology Clinic, Ospedale Clinicizzato, Chieti, Italy; Department of Neuroscience and Imaging, Aging Research Center, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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18
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Ascertainment bias in dementias: a secondary to tertiary centre analysis in Central Italy and conceptual review. Aging Clin Exp Res 2013; 25:265-74. [PMID: 23784725 DOI: 10.1007/s40520-013-0039-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Ascertainment bias (AB) indicates a bias of an evaluation centre in estimating the prevalence/incidence of a disease due to the specific expertise of the centre. The aim of our study was to evaluate classification of different types of dementia in new cases appearing in secondary and tertiary centres, in order to evidence possible occurrence of AB in the various (secondary to tertiary) dementia centres. METHODS To assess the mechanism of AB, the rates of new cases of the different forms of dementia reported by different centres were compared. The centres involved in the study were 11 hospital-based centres including a tertiary centre, located in the University Department of Clinical Neurology. The tertiary centre is endowed with state-of-the-art diagnostic facilities and its scientific production is prominently focused on dementia with Lewy bodies (DLB) thus suggesting the possible occurrence of a bias. Four main categories of dementia were identified: Alzheimer's disease (AD), DLB, fronto-temporal dementia (FTD), vascular dementia (VaD), with other forms in a category apart. The classification rate of new cases of dementia in the tertiary centre was compared with rates reported by secondary centres and rates of recoding were calculated during a follow-up of 2 years. RESULTS The study classified 2,042 newly diagnosed cases of dementia in a population of 1,370,000 inhabitants of which 315,000 were older than 65. AD was categorized in 48-52 % of cases, DLB in 25-28 %, FTD in 2-4 % and VaD in 17-28 %. During the 2-year follow-up the diagnosis was re-classified in 40 patients (3 %). The rate of recoding was 5 % in the tertiary centre, 2-8 % in referrals from secondary to tertiary centre, 2-10 % in recodings performed in secondary centres and addressed to tertiary centre. Recoding or percentages of new cases of AD or DLB were not different in the comparison between secondary or between secondary and tertiary centres. FTD and VaD were instead significantly recoded. CONCLUSION The results of the study suggest that in a homogeneous area, AB is not interfering with diagnosis of AD or DLB.
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