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DeRosier F, Hibbs C, Alessi K, Padda I, Rodriguez J, Pradeep S, Parmar MS. Progressive supranuclear palsy: Neuropathology, clinical presentation, diagnostic challenges, management, and emerging therapies. Dis Mon 2024:101753. [PMID: 38908985 DOI: 10.1016/j.disamonth.2024.101753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by the accumulation of 4R-tau protein aggregates in various brain regions. PSP leads to neuronal loss, gliosis, and tau-positive inclusions, such as neurofibrillary tangles, tufted astrocytes, and coiled bodies. These pathological changes mainly affect the brainstem and the basal ganglia, resulting in distinctive MRI features, such as the hummingbird and morning glory signs. PSP shows clinical heterogeneity and presents as different phenotypes, the most classical of which is Richardson's syndrome (PSP-RS). The region of involvement and the mode of atrophy spread can further distinguish subtypes of PSP. PSP patients can experience various signs and symptoms, such as postural instability, supranuclear ophthalmoplegia, low amplitude fast finger tapping, and irregular sleep patterns. The most common symptoms of PSP are postural instability, falls, vertical gaze palsy, bradykinesia, and cognitive impairment. These features often overlap with those of Parkinson's disease (PD) and other Parkinsonian syndromes, making the diagnosis challenging. PSP is an essential clinical topic to research because it is a devastating and incurable disease. However, there are still many gaps in knowledge about its pathophysiology, diagnosis, and treatment. Several clinical trials are underway to test noveltherapies that target tau in various ways, such as modulating its post-translational modifications, stabilizing its interaction with microtubules, or enhancing its clearance by immunotherapy. These approaches may offer new hope for slowing down the progression of PSP. In this review, we aim to provide an overview of the current knowledge on PSP, from its pathogenesis to its management. We also discuss the latest advances and future directions in PSP research.
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Affiliation(s)
- Frederick DeRosier
- Department of Foundational Sciences, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL, United States of America
| | - Cody Hibbs
- Department of Foundational Sciences, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL, United States of America
| | - Kaitlyn Alessi
- Department of Family Medicine, University of Florida, Gainesville, United States of America
| | - Inderbir Padda
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, New York, United States of America
| | - Jeanette Rodriguez
- Department of Family Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, Florida, United States of America
| | - Swati Pradeep
- Department of Movement Disorders, UTHealth Houston Neurosciences Neurology - Texas Medical Center, Texas, United States of America
| | - Mayur S Parmar
- Department of Foundational Sciences, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL, United States of America.
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Nysetvold E, Lopez LN, Cogell AN, Fryk H, Pace ND, Taylor SS, Rhoden J, Nichols CA, Pillas D, Klein A, Gasalla T, Scowcroft A. Progressive Supranuclear palsy (PSP) disease progression, management, and healthcare resource utilization: a retrospective observational study in the US and Canada. Orphanet J Rare Dis 2024; 19:215. [PMID: 38778404 PMCID: PMC11112758 DOI: 10.1186/s13023-024-03168-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/30/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a rare neurodegenerative brain disease with rapid progression and currently limited treatment options. A comprehensive understanding of disease progression, management, and healthcare resource utilization is limited, and further research is challenging due to the small population of patients. To address these challenges in conducting PSP research, individuals with PSP were recruited using a multichannel approach tailored specifically to the PSP community. We performed a retrospective observational study using data abstracted from participant medical records collected from multiple patient care centers. RESULTS Seventy-two individuals with PSP were eligible for inclusion. On average, 144 medical documents per participant were collected from an average of 2.9 healthcare centers per participant, with a mean study period of 7.9 years. Among participants with a date of symptom onset documented in the medical records, the median time for the onset of the first fall was 2.0 years (IQR 3.2) before diagnosis, the median onset of unsteady gait or gait impairment was 1.2 years (IQR 1.8) before diagnosis, and the median onset of mobility problems was 0.8 years (IQR 1.8) before diagnosis. The most widely utilized healthcare resources, with at least 85% of participants using each of these resources at some point during the disease course, were medications (100%), imaging (99%), assistive devices (90%), supportive care (86%), and surgeries and procedures (85%). CONCLUSIONS This retrospective study adds to the current understanding of PSP symptoms, comorbidities, and healthcare resource utilization (HRU) across the disease journey. By involving individuals with PSP and their caregivers or legally authorized representatives in the research process, this study was unique in its approach to participant recruitment and enabled individuals to participate in research without the need for travel. We collected medical documents from multiple healthcare centers, allowing for broad data collection covering the entire disease journey. This approach to the collection of real-world data may be used to generate valuable insights into many aspects of disease progression and management in PSP and many other rare diseases.
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Affiliation(s)
| | | | | | | | | | | | - Joyce Rhoden
- AllStripes Research, San Francisco, California, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Glinzer J, Flynn É, Tampoukari E, Harpur I, Walshe M. Dysphagia Prevalence in Progressive Supranuclear Palsy: A Systematic Review and Meta-Analysis. Dysphagia 2024:10.1007/s00455-024-10681-7. [PMID: 38523230 DOI: 10.1007/s00455-024-10681-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/02/2024] [Indexed: 03/26/2024]
Abstract
The objective of this systematic review was to determine the prevalence of dysphagia and aspiration in people with progressive supranuclear palsy (PSP). A search of six electronic databases was performed from inception to April 2022. No context restrictions were set. All primary research comprising figures to derive a prevalence rate were included. Two independent reviewers screened search results. Data were extracted by one reviewer. Conflicts were resolved by discussion with a third reviewer. The quality of included studies was assessed using the JBI Checklist for Prevalence Studies. From 877 studies, 12 were eligible for inclusion. Dysphagia had to be confirmed using instrumental assessments, clinical swallowing evaluation, screening, and patient-reported outcome measures (PROM). A random-effects meta-analysis calculated a pooled dysphagia prevalence in 78-89% (95% CI [60.6, 89.1], [78.9, 95.0]). depending on the chosen assessment method, and a pooled aspiration prevalence of 23.5% (95% CI [14.5, 33.7]). The included studies were of moderate quality, with high risk of selection and coverage bias and low to moderate risk of measurement bias. Dysphagia is highly prevalent in a sample of participants with mostly moderately severe PSP. Aspiration occurs in a quarter of this sample and is likely to increase as the disease progresses. Given the low general prevalence of PSP, studies remain at high risk for selection bias. Prospective research should focus on the development of dysphagia in the course of PSP and its subcategories using instrumental assessment and consider all phases of swallowing. REGISTRATION: The protocol of this systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) in April 2021 (registration number: CRD42021245204).
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Affiliation(s)
- Julia Glinzer
- Department of Clinical Speech and Language Studies, Trinity College Dublin, University of Dublin, Dublin 2, Ireland
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Éadaoin Flynn
- Department of Clinical Speech and Language Studies, Trinity College Dublin, University of Dublin, Dublin 2, Ireland
- Department of Speech and Language Therapy, Tallaght University Hospital, Dublin, Ireland
| | - Eleni Tampoukari
- Department of Clinical Speech and Language Studies, Trinity College Dublin, University of Dublin, Dublin 2, Ireland
| | - Isolde Harpur
- The Library of Trinity College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, University of Dublin, Dublin 2, Ireland.
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Street D, Bevan-Jones WR, Malpetti M, Jones PS, Passamonti L, Ghosh BC, Rittman T, Coyle-Gilchrist IT, Allinson K, Dawson CE, Rowe JB. Structural correlates of survival in progressive supranuclear palsy. Parkinsonism Relat Disord 2023; 116:105866. [PMID: 37804622 PMCID: PMC7615224 DOI: 10.1016/j.parkreldis.2023.105866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/12/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Many studies of the Richardson's syndrome phenotype of progressive supranuclear palsy (PSP) have elucidated regions of progressive atrophy and neural correlates of clinical severity. However, the neural correlates of survival and how these differ according to variant phenotypes are poorly understood. We set out to identify structural changes that predict severity and survival from scanning date to death. METHODS Structural magnetic resonance imaging data from 112 deceased people with clinically defined 'probable' or 'possible' PSP were analysed. Neuroanatomical regions of interest volumes, thickness and area were correlated with 'temporal stage', defined as the ratio of time from symptom onset to death, time from scan to death ('survival from scan'), and in a subset of patients, clinical severity, adjusting for age and total intracranial volume. Forty-nine participants had post mortem confirmation of the diagnosis. RESULTS Using T1-weighted magnetic resonance imaging, we confirmed the midbrain, and bilateral cortical structural correlates of contemporary disease severity. Atrophy of the striatum, cerebellum and frontotemporal cortex correlate with temporal stage and survival from scan, even after adjusting for severity. Subcortical structure-survival relationships were stronger in Richardson's syndrome than variant phenotypes. CONCLUSIONS Although the duration of PSP varies widely between people, an individual's progress from disease onset to death (their temporal stage) reflects atrophy in striatal, cerebellar and frontotemporal cortical regions. Our findings suggest magnetic resonance imaging may contribute to prognostication and stratification of patients with heterogenous clinical trajectories and clarify the processes that confer mortality risk in PSP.
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Affiliation(s)
- Duncan Street
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | | | - Maura Malpetti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - P Simon Jones
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Consiglio Nazionale Delle Ricerche (CNR), Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), Milano, Italy
| | - Boyd Cp Ghosh
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Wessex Neurological Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Timothy Rittman
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - Ian Ts Coyle-Gilchrist
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Norfolk and Norwich NHS Foundation Trust, Norwich, UK
| | - Kieren Allinson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; Department of Pathology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Catherine E Dawson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, UK; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
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Iwashita Y, Umemoto G, Fujioka S, Arahata H, Dotsu Y, Oike A, Tsuboi Y. Factors that impact dysphagia and discontinuance of oral intake in patients with progressive supranuclear palsy. Front Neurol 2023; 14:1259327. [PMID: 37780702 PMCID: PMC10533936 DOI: 10.3389/fneur.2023.1259327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Objective To evaluate the swallowing function in the advanced stages of progressive supranuclear palsy (PSP) and clarify the factors that lead to adjustment of food consistency and discontinuation of oral intake. Methods A total of 56 patients with PSP were recruited. Based on medical records, information about the basic attributes, clinical features (including axial rigidity and dementia), food intake, the results of a videofluoroscopic swallowing study (VFSS), and the timing of nasogastric tube transition and gastrostomy were extracted. From the VFSS images, the presence or absence of aspiration and retrocollis were assessed. Results The average age at the onset, diagnosis, and the final follow-up examination were 67.6 ± 6.4 years, 71.6 ± 5.8 years, and 75.4 ± 5.6 years, respectively. The average duration of illness was 64.6 ± 42.8 months. Twenty-four individuals (42.9%) were continuing oral intake, while 32 were tube-fed, among whom 16 (50.0%) underwent gastrostomy tube placement. There were significant differences in the duration from the disease onset to tube feeding between the patients with and without cognitive decline at the time of the diagnosis (p < 0.01) and in the duration from the initial VFSS to tube feeding between the patients with and without aspiration on the initial VFSS (p < 0.01). There were significant differences in the duration from the diagnosis to tube feeding and from the initial VFSS to tube feeding between patients with and without axial rigidity at the time of the diagnosis (p < 0.05 and p < 0.05, respectively). Additionally, there was a significant association between axial rigidity and retrocollis (p < 0.01). Conclusion Cognitive decline, axial rigidity and retrocollis, which are associated with the deterioration of dysphagia in PSP, are the highest risk factors for the discontinuation of oral intake. The early identification of these factors associated with the progression of dysphagia can contribute to the improvement of patient care and management.
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Affiliation(s)
- Yuki Iwashita
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan
| | - George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan
- Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hajime Arahata
- Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan
| | - Yuriko Dotsu
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan
| | - Asami Oike
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Bessemer R, Iansavichene A, Jenkins ME, Finger E, Gofton TE. Clinical milestones as triggers for palliative care intervention in progressive Supranuclear palsy and multiple system atrophy. J Neurol Sci 2023; 448:120614. [PMID: 37001415 DOI: 10.1016/j.jns.2023.120614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/31/2023]
Abstract
not required for reviews.
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Affiliation(s)
- Robin Bessemer
- Department of Clinical Neurologic Sciences, Schulich School of Medicine and Dentistry, Western University; 339 Windermere Road London, Ontario N6A 5A5, Canada
| | - Alla Iansavichene
- Library Services, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada
| | - Mary E Jenkins
- Department of Clinical Neurologic Sciences, Schulich School of Medicine and Dentistry, Western University; 339 Windermere Road London, Ontario N6A 5A5, Canada
| | - Elizabeth Finger
- Department of Clinical Neurologic Sciences, Schulich School of Medicine and Dentistry, Western University; 339 Windermere Road London, Ontario N6A 5A5, Canada
| | - Teneille E Gofton
- Department of Clinical Neurologic Sciences, Schulich School of Medicine and Dentistry, Western University; 339 Windermere Road London, Ontario N6A 5A5, Canada.
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Régy M, Dugravot A, Sabia S, Bouaziz-Amar E, Paquet C, Hanseeuw B, Singh-Manoux A, Dumurgier J. Association between ATN profiles and mortality in a clinical cohort of patients with cognitive disorders. Alzheimers Res Ther 2023; 15:77. [PMID: 37038213 PMCID: PMC10088112 DOI: 10.1186/s13195-023-01220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is the 5th leading cause of death in people 65 years and older. The ATN classification reflects a biological definition of AD pathology with markers of Aβ deposition (A), pathologic tau (T), and neurodegeneration (N). Little is known about the relationship between ATN status and the risk of mortality, leading us to examine this association in a relatively large population of patients seen at a memory clinic for cognitive disorders. METHODS Data were drawn from the BioCogBank Study, including patients seen for cognitive disorders in Lariboisiere Hospital (Paris, France), followed up to 15 years. All participants underwent a lumbar puncture for an assessment of the levels of CSF tau (tau), phosphorylated tau (p-tau181), and β-amyloid 42 peptide (Aβ42). Vital status on July 1, 2020, was recorded for each participant using the national mortality register. Individuals were categorized according to their ATN profiles based on CSF Aβ42 or Aβ42/40 ratio, p-tau181, and tau. Kaplan-Meier and multivariate Cox analyses were performed with A-T-N - participants as the reference using a short (5 years) and long follow-up (15 years). RESULTS Of the 1353 patients in the study (mean age: 68 years old, 53% of women, mean MMSE score: 22.6), 262 died during the follow-up. At 5 years of follow-up, A-T-N + individuals had the highest risk of mortality in Kaplan-Meier and adjusted Cox analyses [HR (95% CI) = 2.93 (1.31-6.56)]. At 15 years of follow-up, patients in the AD spectrum had a higher mortality risk with a gradient effect for biomarker positivity: A-T + [HR = 1.63 (1.04-2.55)], A + T - [HR = 2.17 (1.44-3.26)], and A + T + individuals [HR = 2.38 (1.66-3.39)], compared to A-T-N - patients. Adjustments on potential confounders had little impact on these associations. CONCLUSION This study shows ATN profiles to be associated with mortality in a relatively large patient cohort based on a memory clinic. Patients with isolated evidence of neurodegeneration had a higher mortality rate in the short follow-up, and patients with the AD profile had the highest mortality rate in the long follow-up.
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Affiliation(s)
- Mélina Régy
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Université Catholique de Louvain, Brussels, Belgium
| | - Aline Dugravot
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Séverine Sabia
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Elodie Bouaziz-Amar
- Université Paris-Cité, Department of Biochemistry, GHU APHP Nord Lariboisière Fernand-Widal Hospital, Paris, France
| | - Claire Paquet
- Université Paris-Cité, Inserm U1144, Cognitive Neurology Center, GHU APHP Nord Lariboisière Fernand-Widal Hospital, Paris, France
| | - Bernard Hanseeuw
- Université Catholique de Louvain, Brussels, Belgium
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Julien Dumurgier
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.
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Circadian disruption and sleep disorders in neurodegeneration. Transl Neurodegener 2023; 12:8. [PMID: 36782262 PMCID: PMC9926748 DOI: 10.1186/s40035-023-00340-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
Disruptions of circadian rhythms and sleep cycles are common among neurodegenerative diseases and can occur at multiple levels. Accumulating evidence reveals a bidirectional relationship between disruptions of circadian rhythms and sleep cycles and neurodegenerative diseases. Circadian disruption and sleep disorders aggravate neurodegeneration and neurodegenerative diseases can in turn disrupt circadian rhythms and sleep. Importantly, circadian disruption and various sleep disorders can increase the risk of neurodegenerative diseases. Thus, harnessing the circadian biology findings from preclinical and translational research in neurodegenerative diseases is of importance for reducing risk of neurodegeneration and improving symptoms and quality of life of individuals with neurodegenerative disorders via approaches that normalize circadian in the context of precision medicine. In this review, we discuss the implications of circadian disruption and sleep disorders in neurodegenerative diseases by summarizing evidence from both human and animal studies, focusing on the bidirectional links of sleep and circadian rhythms with prevalent forms of neurodegeneration. These findings provide valuable insights into the pathogenesis of neurodegenerative diseases and suggest a promising role of circadian-based interventions.
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Sotirakis C, Conway N, Su Z, Villarroel M, Tarassenko L, FitzGerald JJ, Antoniades CA. Longitudinal Monitoring of Progressive Supranuclear Palsy using Body-Worn Movement Sensors. Mov Disord 2022; 37:2263-2271. [PMID: 36054142 DOI: 10.1002/mds.29194] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We have previously shown that wearable technology and machine learning techniques can accurately discriminate between progressive supranuclear palsy (PSP), Parkinson's disease, and healthy controls. To date these techniques have not been applied in longitudinal studies of disease progression in PSP. OBJECTIVES We aimed to establish whether data collected by a body-worn inertial measurement unit (IMU) network could predict clinical rating scale scores in PSP and whether it could be used to track disease progression. METHODS We studied gait and postural stability in 17 participants with PSP over five visits at 3-month intervals. Participants performed a 2-minute walk and an assessment of postural stability by standing for 30 seconds with their eyes closed, while wearing an array of six IMUs. RESULTS Thirty-two gait and posture features were identified, which progressed significantly with time. A simple linear regression model incorporating the three features with the clearest progression pattern was able to detect statistically significant progression 3 months in advance of the clinical scores. A more complex linear regression and a random forest approach did not improve on this. CONCLUSIONS The reduced variability of the models, in comparison to clinical rating scales, allows a significant change in disease status from baseline to be observed at an earlier stage. The current study sheds light on the individual features that are important in tracking disease progression. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Charalampos Sotirakis
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Niall Conway
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Zi Su
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Mauricio Villarroel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - James J FitzGerald
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Chrystalina A Antoniades
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Increased Subcortical Sodium Levels in Patients with Progressive Supranuclear Palsy. Biomedicines 2022; 10:biomedicines10071728. [PMID: 35885033 PMCID: PMC9313136 DOI: 10.3390/biomedicines10071728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Progressive supranuclear palsy (PSP) is a debilitating neurodegenerative disease characterized by an aggressive disease course. Total and intracellular-weighted sodium imaging (23Na-MRI) is a promising method for investigating neurodegeneration in vivo. We enrolled 10 patients with PSP and 20 age- and gender-matched healthy control subjects; all study subjects underwent a neurological examination, whole-brain structural, and (total and intracellular-weighted) 23Na-MRI. Voxel-wise analyses revealed increased brainstem total sodium content in PSP that correlated with disease severity. The ROI-wise analysis highlighted additional sodium level changes in other regions implicated in the pathophysiology of PSP. 23Na-MRI yields substantial benefits for the diagnostic workup of patients with PSP and adds complementary information on the underlying neurodegenerative tissue changes in PSP.
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Pillas D, Klein A, Gasalla T, Avbersek A, Thompson A, Wright J, Mellor J, Scowcroft A. The Burden of Progressive Supranuclear Palsy on Patients, Caregivers, and Healthcare Systems by PSP Phenotype: A Cross-Sectional Study. Front Neurol 2022; 13:821570. [PMID: 35865639 PMCID: PMC9295700 DOI: 10.3389/fneur.2022.821570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/09/2022] [Indexed: 12/03/2022] Open
Abstract
Progressive supranuclear palsy (PSP) is a rare, relentlessly progressive, ultimately fatal neurodegenerative brain disease. The objective of this study was to assess the burden of PSP on patients, caregivers, and healthcare systems by PSP phenotype. Data were drawn from the Adelphi PSP Disease Specific Programme™, a cross-sectional study of neurologists and people living with PSP in the United States of America, France, Germany, Italy, Spain, and the United Kingdom. All people living with PSP with a reported phenotype were included. PSP phenotype was reported for 242 patients (mean age: 70.2 years, 58% male): PSP-Richardson's syndrome, n = 96; PSP-predominant Parkinsonism, n = 88; PSP-predominant corticobasal syndrome, n = 28; PSP-predominant speech/language disorder, n = 12; PSP-progressive gait freezing, n = 9; PSP-predominant frontal presentation, n = 9. Most patients reported impaired cognitive, motor, behavioral and ocular functionality; 67–100% of patients (across phenotypes) had moderate-to-severe disease at the time of data collection. Post-diagnosis, the majority were provided with a visual and/or mobility aid (55–100%, across phenotypes), and/or required home modification to facilitate their needs (55–78%, across phenotypes). Patients required multiple types of healthcare professionals for disease management (mean 3.6–4.4, across phenotypes), and the majority reported receiving care from at least one caregiver (mean 1.3–1.8, across phenotypes). There is a high burden on patients, caregivers, and healthcare systems across all PSP phenotypes. Although phenotypes manifest different symptoms and are associated with different diagnostic pathways, once diagnosed with PSP, patients typically receive similar care.
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Affiliation(s)
| | | | | | | | | | - Jack Wright
- Rare Disease Franchise, Adelphi Real World, Bollington, United Kingdom
| | - Jennifer Mellor
- Rare Disease Franchise, Adelphi Real World, Bollington, United Kingdom
| | - Anna Scowcroft
- UCB Pharma, Brussels, Belgium
- *Correspondence: Anna Scowcroft
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Iohan LDCC, Lambert JC, Costa MR. Analysis of modular gene co-expression networks reveals molecular pathways underlying Alzheimer’s disease and progressive supranuclear palsy. PLoS One 2022; 17:e0266405. [PMID: 35421130 PMCID: PMC9009680 DOI: 10.1371/journal.pone.0266405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/18/2022] [Indexed: 12/02/2022] Open
Abstract
A comprehensive understanding of the pathological mechanisms involved at different stages of neurodegenerative diseases is key for the advance of preventive and disease-modifying treatments. Gene expression alterations in the diseased brain is a potential source of information about biological processes affected by pathology. In this work, we performed a systematic comparison of gene expression alterations in the brains of human patients diagnosed with Alzheimer’s disease (AD) or Progressive Supranuclear Palsy (PSP) and animal models of amyloidopathy and tauopathy. Using a systems biology approach to uncover biological processes associated with gene expression alterations, we could pinpoint processes more strongly associated with tauopathy/PSP and amyloidopathy/AD. We show that gene expression alterations related to immune-inflammatory responses preponderate in younger, whereas those associated to synaptic transmission are mainly observed in older AD patients. In PSP, however, changes associated with immune-inflammatory responses and synaptic transmission overlap. These two different patterns observed in AD and PSP brains are fairly recapitulated in animal models of amyloidopathy and tauopathy, respectively. Moreover, in AD, but not PSP or animal models, gene expression alterations related to RNA splicing are highly prevalent, whereas those associated with myelination are enriched both in AD and PSP, but not in animal models. Finally, we identify 12 AD and 4 PSP genetic risk factors in cell-type specific co-expression modules, thus contributing to unveil the possible role of these genes to pathogenesis. Altogether, this work contributes to unravel the potential biological processes affected by amyloid versus tau pathology and how they could contribute to the pathogenesis of AD and PSP.
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Affiliation(s)
- Lukas da Cruz Carvalho Iohan
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil
- Bioinformatics Multidisciplinary Environment, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Jean-Charles Lambert
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, DISTALZ, Lille, France
| | - Marcos R. Costa
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, DISTALZ, Lille, France
- * E-mail:
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13
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Pereira MF, Buchanan T, Höglinger GU, Bogdanovic M, Tofaris G, Prangnell S, Sarangmat N, FitzGerald JJ, Antoniades CA. Longitudinal changes of early motor and cognitive symptoms in progressive supranuclear palsy: the OxQUIP study. BMJ Neurol Open 2022; 4:e000214. [PMID: 35128403 PMCID: PMC8785161 DOI: 10.1136/bmjno-2021-000214] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/19/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a rare neurodegenerative condition characterised by a range of motor and cognitive symptoms. Very little is known about the longitudinal change in these symptoms over time. Moreover, the effectiveness of clinical scales to detect early changes in PSP is still a matter of debate. OBJECTIVE We aimed to determine longitudinal changes in PSP features using multiple closely spaced follow-up time points over a period of 2 years. Methods 28 healthy control and 28 PSP participants, with average time since onset of symptoms of 1.9 years, were prospectively studied every 3 months for up to 24 months. Changes from baseline scores were calculated at each follow-up time point using multiple clinical scales to identify longitudinal progression of motor and cognitive symptoms. RESULTS The Montreal Cognitive Assessment, but not the Mini-Mental State Examination, detected cognitive decline at baseline. Both scales revealed poor longitudinal sensitivity to clinical change in global cognitive symptoms. Conversely, the Movement Disorders Society Unified Parkinson's disease Rating Scale - part III and the PSP Rating Scale (PSPRS) reliably detected motor decline less than 2 years after disease onset. The 'Gait/Midline' PSPRS subscore consistently declined over time, with the earliest change being observed 6 months after baseline assessment. CONCLUSION While better cognitive screening tools are still needed to monitor cognitive decline in PSP, motor decline is consistently captured by clinical rating scales. These results support the inclusion of multiple follow-up time points in longitudinal studies in the early stages of PSP.
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Affiliation(s)
- Marta F Pereira
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Günter U Höglinger
- Department of Neurology, Technische Universität München & Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Munich, Germany
| | - Marko Bogdanovic
- Department of Neurology, Oxford University Hospitals, Oxford, UK
| | - George Tofaris
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Simon Prangnell
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - James J FitzGerald
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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14
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Ali F, Loushin SR, Botha H, Josephs KA, Whitwell JL, Kaufman K. Laboratory based assessment of gait and balance impairment in patients with progressive supranuclear palsy. J Neurol Sci 2021; 429:118054. [PMID: 34461552 PMCID: PMC8489851 DOI: 10.1016/j.jns.2021.118054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/27/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gait and balance abnormalities are a significant source of morbidity and mortality in progressive supranuclear palsy (PSP). Gait impairment in PSP is primarily assessed clinically on exam or with the use of rating scales. Three dimensional video based gait and balance analysis performed in a laboratory setting is a highly accurate method of motion analysis (Wren et al., 2020), however limited data is available in patients with PSP. RESEARCH QUESTION In this study we assess the objective features of postural control, kinematics, kinetic and temporal-spatial gait metrics in PSP, using three-dimensional video motion analysis in a laboratory setting compared to normal controls. METHODS Three-dimensional motion was captured using a 10-camera motion capture system, 41 body markers and ground embedded force plates in 16 patients with PSP patients and compared to motorically normal controls. RESULTS Spatiotemporal, kinematic, and kinetic gait measures effectively differentiated patients with PSP from controls. Patients had slower gait velocity, lower cadence, increased double support time and abnormal antero-posterior sway. Joint kinematics and kinetics were reduced and showed less variation among patients with PSP compared to controls which is suggestive of bradykinesia. Objective gait measures of abnormality correlated with clinical disease severity. Postural sway metrics distinguished PSP from controls and captured gait imbalance. SIGNIFICANCE Objective measures of gait and balance abnormalities in patients with PSP provide an outcome measure that can be potentially used for early disease detection, in clinical trials and to validate portable motion capture devices in the future.
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Affiliation(s)
- Farwa Ali
- Department of Neurology, Rochester, MN, United States of America.
| | - Stacy R Loushin
- Department of Orthopedic Surgery, Rochester, MN, United States of America
| | - Hugo Botha
- Department of Neurology, Rochester, MN, United States of America
| | - Keith A Josephs
- Department of Neurology, Rochester, MN, United States of America
| | - Jennifer L Whitwell
- Department of Radiology, Mayo Clinic Rochester, Rochester, MN, United States of America
| | - Kenton Kaufman
- Department of Orthopedic Surgery, Rochester, MN, United States of America
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15
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Hokelekli FO, Ali F, Carlos AF, Martin PR, Clark HM, Duffy JR, Utianski RL, Botha H, St Louis EK, Whitwell JL, Josephs KA. Sleep disturbances in the speech-language variant of progressive supranuclear palsy. Parkinsonism Relat Disord 2021; 91:9-12. [PMID: 34425331 DOI: 10.1016/j.parkreldis.2021.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/15/2021] [Accepted: 08/15/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Progressive supranuclear palsy (PSP) variants other than PSP-Richardson Syndrome (PSP-RS) have been recognized, including PSP with speech and language problems (PSP-SL). Given the reported sleep disruptions in PSP-RS, we investigated sleep abnormalities in PSP-SL. METHODS Four sleep-related screening questions were given to the caregivers of 90 patients with PSP-SL (59 suggestive of PSP-SL and 31 possible PSP-SL) and 71 probable PSP-RS (prob. PSP-RS) patients. RESULTS At least one sleep-related disturbance was observed in 35.6% of suggestive of PSP-SL, 38.7% of possible PSP-SL, and 67.6% of prob. PSP-RS, the most common being "unable to fall or stay asleep". Prob. PSP-RS showed higher frequency of "screaming or talking in sleep", "acting out dreams", and "unable to fall or stay asleep" compared to both PSP-SL groups, but did not differ from possible PSP-SL in "excessive daytime sleepiness". CONCLUSION Sleep abnormalities are common in PSP-SL, but less frequent than prob.PSP-RS.
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Affiliation(s)
| | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Arenn F Carlos
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Peter R Martin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Erik K St Louis
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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16
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Kwasny MJ, Oleske DM, Zamudio J, Diegidio R, Höglinger GU. Clinical Features Observed in General Practice Associated With the Subsequent Diagnosis of Progressive Supranuclear Palsy. Front Neurol 2021; 12:637176. [PMID: 33967937 PMCID: PMC8100604 DOI: 10.3389/fneur.2021.637176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Progressive supranuclear palsy (PSP) is a rare neurodegenerative disorder that is difficult for primary care physicians to recognize due to its progressive nature and similarities to other neurologic disorders. This case-control study aimed to identify clinical features observed in general practice associated with a subsequent diagnosis of PSP. Methods: We analyzed a de-identified dataset of 152 PSP cases and 3,122 matched controls from electronic medical records of general practices in Germany. We used a random forests algorithm based on machine learning techniques to identify clinical features (medical conditions and treatments received) associated with pre-diagnostic PSP without using an a priori hypothesis. We then assessed the relative effects of the features with the highest importance scores and generated multivariate models using clustered logistic regression analyses to identify a subset of clinical features associated with subsequent PSP diagnosis. Results: Using the random forests approach, we identified 21 clinical features associated with pre-diagnostic PSP (odds ratio ≥2.0 in univariate analyses). From these, we constructed a multivariate model comprising 9 clinical features with ~90% likelihood of identifying a subsequent PSP diagnosis. These features included known PSP symptoms, common misdiagnoses, and 2 novel associations, diabetes mellitus and cerebrovascular disease, which are possible modifiable risk factors for PSP. Conclusion: In this case-control study using data from electronic medical records, we identified 9 clinical features, including 2 previously unknown factors, associated with the pre-diagnostic stage of PSP. These may be used to facilitate recognition of PSP and reduce time to referral by primary care physicians.
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Affiliation(s)
- Mary J Kwasny
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Denise M Oleske
- Global Epidemiology, AbbVie Inc., North Chicago, IL, United States
| | - Jorge Zamudio
- Global Medical Affairs, AbbVie Inc., North Chicago, IL, United States
| | - Robert Diegidio
- Global Epidemiology, AbbVie Inc., North Chicago, IL, United States
| | - Günter U Höglinger
- Department of Neurology, Hannover Medical School, Hannover, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
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17
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Stang CD, Turcano P, Mielke MM, Josephs KA, Bower JH, Ahlskog JE, Boeve BF, Martin PR, Upadhyaya SG, Savica R. Incidence and Trends of Progressive Supranuclear Palsy and Corticobasal Syndrome: A Population-Based Study. JOURNAL OF PARKINSONS DISEASE 2021; 10:179-184. [PMID: 31594251 DOI: 10.3233/jpd-191744] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few studies have investigated the incidence of PSP and CBS in the population. OBJECTIVE To examine the incidence of and trends in progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) in a population-based cohort of residents of Olmsted County, MN. METHODS We used the 1991-2005 population-based, Olmsted County Parkinsonism-cohort study, defined via the Rochester Epidemiology Project. A movement-disorder specialist reviewed medical records, to confirm PSP and CBS diagnoses. RESULTS We identified 21 patients with these diagnoses 1991-2005 : 18 (85.7%), PSP; 3 (14.3%), CBS. The median diagnosis age was 78 (range: 66-88). 13/21 (62.0%) were male. MRI was performed pre-diagnosis in 11 patients (8 PSP and 3 CBD); 10 showed atrophy consistent with clinical diagnoses. We observed concordance between clinical and pathological diagnoses in two PSP patients who underwent autopsy. Combined incidence for PSP and CBS in Olmsted County was 3.1 per 100,000 person-years (2.6 per 100,000 person-years, PSP; 0.4 per 100,000 person-years, CBS). Incidence was higher in men (4.5, 95% CI, 2.0-7.0) than women (1.8, 95% CI, 0.5-2.9). A combined, significant trend of increasing incidence was observed between 1991 and 2005 (B=0.69, 95% CI 0.42, 0.96, p<0.001). Median time from symptom onset to death among both groups was 6 years (range PSP, 1-10 years; range CBS, 3-8 years). CONCLUSIONS The combined incidence for PSP and CBS was 3.1 per 100,000 person-years, higher in men than women. We observed a significant increase in both PSP and CBS, likely due to advancing imaging technology and improved diagnostic ability among physicians.
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Affiliation(s)
- Cole D Stang
- Mayo Clinic Department of Neurology, Rochester, MN, USA
| | | | - Michelle M Mielke
- Mayo Clinic Department of Health Sciences Research, Rochester, MN, USA
| | | | - James H Bower
- Mayo Clinic Department of Neurology, Rochester, MN, USA
| | | | | | - Peter R Martin
- Mayo Clinic Department of Health Sciences Research, Rochester, MN, USA
| | | | - Rodolfo Savica
- Mayo Clinic Department of Neurology, Rochester, MN, USA.,Mayo Clinic Department of Health Sciences Research, Rochester, MN, USA
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18
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El-Wahsh S, Finger EC, Piguet O, Mok V, Rohrer JD, Kiernan MC, Ahmed RM. Predictors of survival in frontotemporal lobar degeneration syndromes. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-324349. [PMID: 33441385 DOI: 10.1136/jnnp-2020-324349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/26/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Abstract
After decades of research, large-scale clinical trials in patients diagnosed with frontotemporal lobar degeneration (FTLD) are now underway across multiple centres worldwide. As such, refining the determinants of survival in FTLD represents a timely and important challenge. Specifically, disease outcome measures need greater clarity of definition to enable accurate tracking of therapeutic interventions in both clinical and research settings. Multiple factors potentially determine survival, including the clinical phenotype at presentation; radiological patterns of atrophy including markers on both structural and functional imaging; metabolic factors including eating behaviour and lipid metabolism; biomarkers including both serum and cerebrospinal fluid markers of underlying pathology; as well as genetic factors, including both dominantly inherited genes, but also genetic modifiers. The present review synthesises the effect of these factors on disease survival across the syndromes of frontotemporal dementia, with comparison to amyotrophic lateral sclerosis, progressive supranuclear palsy and corticobasal syndrome. A pathway is presented that outlines the utility of these varied survival factors for future clinical trials and drug development. Given the complexity of the FTLD spectrum, it seems unlikely that any single factor may predict overall survival in individual patients, further suggesting that a precision medicine approach will need to be developed in predicting disease survival in FTLD, to enhance drug target development and future clinical trial methodologies.
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Affiliation(s)
- Shadi El-Wahsh
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Elizabeth C Finger
- Department of Clinicial Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Olivier Piguet
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Vincent Mok
- Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Matthew C Kiernan
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebekah M Ahmed
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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19
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Morgan JC, Ye X, Mellor JA, Golden KJ, Zamudio J, Chiodo LA, Bao Y, Xie T. Disease course and treatment patterns in progressive supranuclear palsy: A real-world study. J Neurol Sci 2020; 421:117293. [PMID: 33385754 DOI: 10.1016/j.jns.2020.117293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a neurodegenerative disorder with symptoms including vertical gaze palsy, frequent falls, abnormal gait, and cognitive/language/behavioral changes, making diagnosis and treatment challenging. METHODS Descriptive analysis was undertaken of cross-sectional, real-world data for patients with PSP provided by neurologists in France, Germany, Italy, Spain, UK, and USA. RESULTS Data on 892 PSP patients were obtained from patient records. Common initial symptoms included difficulty walking/maintaining gait, confusion/disorientation, loss of balance/falling, and rigidity. These symptoms and vertical gaze palsy commonly aided diagnosis. At data collection, dysphagia and blepharospasm were also very common. Mean times from symptom-onset to consulting a healthcare professional and PSP diagnosis were 5.2 and 15.0 months, respectively. General practitioners or movement disorder specialists were most commonly consulted initially; 98% of patients were diagnosed with PSP by a movement disorder specialist or general neurologist. Alternative diagnoses, including Parkinson's disease (67%) and dementia (10%), were considered for 41% of patients prior to PSP diagnosis. Non-wheelchair walking aids and wheelchairs were used by 60% and 23% of patients, respectively, with mean times from symptom-onset to use being 20.8 and 39.5 months, respectively. Symptomatic medication, most often levodopa and antidepressants, was prescribed for 87% of patients. CONCLUSION This study provided information on disease course and treatment for a large number of PSP patients from various countries. PSP carries a considerable clinical burden. Diagnosis is often delayed. Consulting a movement disorder specialist might expediate diagnosis. Currently, only symptomatic treatments are available with a poor satisfaction, and there is an urgent need for disease-modifying agents.
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Affiliation(s)
- John C Morgan
- Movement & Memory Disorders Program, Parkinson Foundation Center of Excellence, Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA.
| | | | | | | | | | | | | | - Tao Xie
- Movement Disorder Program, Department of Neurology, University of Chicago Medicine, Chicago, IL, USA.
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20
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Golbe LI, Ohman-Strickland P, Beisser EB, Elghoul FT. A Convenient Prognostic Tool and Staging System for Progressive Supranuclear Palsy. Mov Disord Clin Pract 2020; 7:664-671. [PMID: 32775512 DOI: 10.1002/mdc3.13010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/03/2020] [Accepted: 05/27/2020] [Indexed: 11/08/2022] Open
Abstract
Background Progressive supranuclear palsy (PSP) causes major disability, shortens life, and as yet has no disease-modifying and little symptomatic treatment. A convenient prognostic tool is needed to assist patients, families, and clinicians in planning care. Objectives We calculated times to acquisition of certain disease milestones and death. Methods We followed a cohort of 417 patients with PSP-Richardson syndrome from 1995 to 2016, applying the Progressive Supranuclear Palsy Rating Scale (PSPRS) at each visit. We generated median times to acquisition of 13 milestones using the input variables of sex, onset age, rate of disease progression from motor symptom onset to initial visit, and PSPRS score at the baseline. Of the outcome milestones, 5 were stages of a new, provisional PSP staging system. The other 8 milestones comprised death and disabling levels of cognitive loss, gaze palsy, dysarthria, dysphagia, and gait/balance impairment. Results We derived median times to milestones, with 25th and 75th percentiles and 95% confidence intervals of the median for baseline PSPRS scores from 25 to 65 (scale range, 0-100). Sex and initial progression velocity significantly influenced the death milestone, but not most of the others. Median time to death ranged from 4.8 years for a man with PSPRS score of 25 and a slow progression velocity from onset to initial visit of 0.51 PSPRS points/month to 1.8 years for a woman with PSPRS 65 and rapid initial velocity of 2.25 points/month. Conclusions We have created a convenient, inexpensive, noninvasive reference for counseling patients with PSP-Richardson syndrome on approximate time to encountering 13 life-altering disease milestones.
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Affiliation(s)
- Lawrence I Golbe
- Department of Neurology Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey USA
| | - Pamela Ohman-Strickland
- Department of Biostatistics and Epidemiology Rutgers School of Public Health Piscataway New Jersey USA
| | - Emily B Beisser
- Department of Neurology Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey USA
| | - Francesca T Elghoul
- Department of Neurology Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey USA
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21
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Cui SS, Ling HW, Du JJ, Lin YQ, Pan J, Zhou HY, Wang G, Wang Y, Xiao Q, Liu J, Tan YY, Chen SD. Midbrain/pons area ratio and clinical features predict the prognosis of progressive Supranuclear palsy. BMC Neurol 2020; 20:114. [PMID: 32228519 PMCID: PMC7106781 DOI: 10.1186/s12883-020-01692-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/19/2020] [Indexed: 11/16/2022] Open
Abstract
Background Progressive supranuclear palsy (PSP) is a rare movement disorder with poor prognosis. This retrospective study aimed to characterize the natural history of PSP and to find predictors of shorter survival and faster decline of activity of daily living. Method All patients recruited fulfilled the movement disorder society (MDS) clinical diagnostic criteria for PSP (MDS-PSP criteria) for probable and possible PSP with median 12 years. Data were obtained including age, sex, date of onset, age at onset (AAO), symptoms reported at first visit and follow-up, date of death and date of institutionalization. Magnetic resonance imaging was collected at the first visit. Endpoints were death and institutionalization. Kaplan-Meier method and Cox proportional hazard model were used to explore factors associated with early death and institutionalization. Results Fifty-nine patients fulfilling MDS-PSP criteria were enrolled in our study. Nineteen patients (32.2%) had died and 31 patients (52.5%) were institutionalized by the end of the follow-up. Predictors associated with poorer survival were late-onset PSP and decreased M/P area ratio. Predictors associated with earlier institutionalization were older AAO and decreased M/P area ratio. Conclusion Older AAO and decreased M/P area ratio were predictors for earlier dearth and institutionalization in PSP. The neuroimaging biomarker M/P area ratio was a predictor for prognosis in PSP.
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Affiliation(s)
- Shi-Shuang Cui
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Geriatrics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua-Wei Ling
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juan-Juan Du
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Qi Lin
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Pan
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai-Yan Zhou
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Wang
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Xiao
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Yan Tan
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Sheng-Di Chen
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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22
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Brown FS, Rowe JB, Passamonti L, Rittman T. Falls in Progressive Supranuclear Palsy. Mov Disord Clin Pract 2019; 7:16-24. [PMID: 31970205 PMCID: PMC6962663 DOI: 10.1002/mdc3.12879] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/16/2019] [Accepted: 11/17/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite falls being an almost universal clinical feature and central to the presentation and diagnostic criteria of progressive supranuclear palsy, our understanding of falls is surprisingly limited and there are few effective treatment options. OBJECTIVES To provide an overview of the topic of the impact, assessment, mechanism, and management of falls in progressive supranuclear palsy. METHODS We performed a literature search for "falls" and "progressive supranuclear palsy" and included additional relevant literature known to us. We synthesized this literature with experience from clinical practice. RESULTS We review current understanding of the pathophysiology of falls, highlighting the roles of the indirect pathway and the pedunculopontine nucleus. We go on to identify shortcomings in commonly used assessments to measure falls. We discuss medical and nonmedical fall prevention strategies, and finally we discuss balancing falls risk against promoting independence. CONCLUSION Falls are central to progressive supranuclear palsy presentation and diagnosis. Indirect locomotor and pedunculopontine nucleus dysfunction are thought to be the neural substrate of falls in this condition. Attempts to measure and prevent falls, by medical and nonmedical means, are currently limited. A personalized approach is advocated in the management of falls.
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Affiliation(s)
- Fraser S. Brown
- Department of Clinical NeurosciencesCambridge University HospitalsCambridgeUnited Kingdom
| | - James B. Rowe
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUnited Kingdom,Department of NeurologyAddenbrooke's HospitalCambridgeUnited Kingdom
| | - Luca Passamonti
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUnited Kingdom,Department of NeurologyAddenbrooke's HospitalCambridgeUnited Kingdom
| | - Timothy Rittman
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUnited Kingdom,Department of NeurologyAddenbrooke's HospitalCambridgeUnited Kingdom
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23
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Affiliation(s)
- Nikolaos Giagkou
- Parkinson’s disease and Movement Disorders Department, Hygeia Hospital, Athens, Greece
| | - Maria Stamelou
- Parkinson’s disease and Movement Disorders Department, Hygeia Hospital, Athens, Greece
- Neurology Clinic, Philipps-University, Marburg, Germany
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24
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Ali F, Josephs K. The diagnosis of progressive supranuclear palsy: current opinions and challenges. Expert Rev Neurother 2018; 18:603-616. [DOI: 10.1080/14737175.2018.1489241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Keith Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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25
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Further evidence for a distinctive atypical degenerative parkinsonism in the Caribbean: A new cluster in the French West Indian Island of Martinique. J Neurol Sci 2018. [DOI: 10.1016/j.jns.2018.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Walsh CM, Ruoff L, Walker K, Emery A, Varbel J, Karageorgiou E, Luong PN, Mance I, Heuer HW, Boxer AL, Grinberg LT, Kramer JH, Miller BL, Neylan TC. Sleepless Night and Day, the Plight of Progressive Supranuclear Palsy. Sleep 2018; 40:4348484. [PMID: 29029214 DOI: 10.1093/sleep/zsx154] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives To elucidate the unique sleep and waking characteristics in progressive supranuclear palsy (PSP), a neurodegenerative disease associated with motor deficits and dementia that largely affects the brainstem and thalamic regions. Methods A total of 20 PSP and 16 healthy older adult controls participated in this study. The participants underwent an overnight polysomnography and multiple sleep latency test (MSLT) the following day. Prior to the MSLT last trial, they were asked to complete the Stanford Sleepiness Scale. Data were assessed for measures of latency to sleep onset, sleep duration, waking, and sleep staging during the night. Mean sleep latency, a measure of daytime sleepiness, sleep onset rapid eye movement (REM) periods, and microsleeps were studied with the MSLT. Spectral analysis of wake electroencephalogram (EEG) was performed for 30-second periods at the start of each MSLT trial. Results PSP took significantly longer time to fall asleep (p < .001), slept less during the night (p ≤ .001), and had more wake after sleep onset than controls (p ≤ .001). PSP had less N2 sleep (p < .05) and N3 sleep (p < .05), and REM sleep (p < .001) than controls. During the MSLT, PSP took significantly longer to fall asleep (p < .001), did not have microsleeps when they remained awake throughout the assessment periods, but were subjectively sleepier than controls (p < .05). Gamma power was increased during wake EEG in PSP (p < .01). Conclusions Sleep/waking regulation and REM sleep regulation are disrupted in PSP, leading to profound sleep deprivation without recuperation. Our findings suggest a diminished homeostatic sleep drive in PSP. This hyperaroused state is unique and is a severely disabling feature of PSP.
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Affiliation(s)
- Christine M Walsh
- Department of Neurology, Memory and Aging Center, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158
| | - Leslie Ruoff
- Department of Mental Health, Stress and Health Research Program, San Francisco VA Medical Center, 4150 Clement Street 116P Building 8, San Francisco, CA 94121
| | - Kathleen Walker
- Department of Neurology, Memory and Aging Center, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158
| | - Alaisa Emery
- Department of Neurology, Memory and Aging Center, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158.,Department of Mental Health, Stress and Health Research Program, San Francisco VA Medical Center, 4150 Clement Street 116P Building 8, San Francisco, CA 94121
| | - Jonathan Varbel
- Department of Mental Health, Stress and Health Research Program, San Francisco VA Medical Center, 4150 Clement Street 116P Building 8, San Francisco, CA 94121
| | - Elissaios Karageorgiou
- Department of Neurology, Memory and Aging Center, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158.,Neurological Institute of Athens, Athens, Greece
| | - Phi N Luong
- Department of Neurology, Memory and Aging Center, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158
| | - Irida Mance
- Department of Neurology, Memory and Aging Center, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158
| | - Hilary W Heuer
- Department of Neurology, Memory and Aging Center, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158
| | - Adam L Boxer
- Department of Neurology, Memory and Aging Center, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158
| | - Lea T Grinberg
- Department of Neurology, Memory and Aging Center, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158.,Department of Pathology, LIM-22, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Joel H Kramer
- Department of Neurology, Memory and Aging Center, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158.,Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94158
| | - Thomas C Neylan
- Department of Mental Health, Stress and Health Research Program, San Francisco VA Medical Center, 4150 Clement Street 116P Building 8, San Francisco, CA 94121.,Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143
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27
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Burrell JR, Hodges JR. Falls in frontotemporal dementia and related syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2018; 159:195-203. [PMID: 30482314 DOI: 10.1016/b978-0-444-63916-5.00012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Frontotemporal dementia (FTD) and related diseases are important causes of younger-onset dementia. Falls may be a source of morbidity and mortality in FTD, but remain underreported, and very few high-quality studies have been performed. In this chapter, we briefly review the clinical features of FTD and related syndromes such as motor neuron disease (MND) and atypical parkinsonian syndromes, such as progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). Falls are frequently encountered in patients who present with FTD syndromes. Although cognitive impairment is associated with falls generally, motor symptoms and signs, as seen in FTD cases that overlap with atypical parkinsonian disorders such as PSP or CBS, or MND, appear to pose the greatest risk. At present, very few systematic studies have been performed to determine the precise frequency, timing, diagnostic implications, and complications of falls in FTD. Further studies are required to understand the scope of this problem, and to develop effective treatments and management strategies.
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Affiliation(s)
- James R Burrell
- Concord Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Brain and Mind Centre, University of Sydney Medical School, Sydney, NSW, Australia.
| | - John R Hodges
- Brain and Mind Centre, University of Sydney Medical School, Sydney, NSW, Australia
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28
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Radicati FG, Martinez Martin P, Fossati C, Chaudhuri KR, Torti M, Rodriguez Blazquez C, Vacca L, Stocchi F. Non motor symptoms in progressive supranuclear palsy: prevalence and severity. NPJ PARKINSONS DISEASE 2017; 3:35. [PMID: 29238748 PMCID: PMC5722941 DOI: 10.1038/s41531-017-0037-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 10/23/2017] [Accepted: 11/17/2017] [Indexed: 01/20/2023]
Abstract
NMSs have been extensively studied in PD patients but not in other forms of parkinsonism such as Progressive Supranuclear Palsy (PSP). The primary objective of this study was to analyze the frequency, severity and the type of non-motor symptoms (NMS) in PSP patients using the non-motor symptoms scale (NMSS). The secondary objective was to differentiate NMS between PSP and Parkinson’s disease (PD). We enrolled in this cross-sectional study 50 consecutive PSP and 100 matched Parkinson’s disease (PD) patients, in the proportion PSP/PD = 1/2, matched in age, sex, and disease duration. Motor and Non Motor symptoms (different scales for each disease) were evaluated at baseline using PSP scale, SCOPA Motor, Montreal Cognitive Assessment (MOCA), HADS, Hamilton, and Non Motor Symptom scale (NMSS). Comparative analysis was done using chi-squared test, Mann-Whitney test and Fisher’s exact test. Fifty PSP (56% female) and 100 PD (59% female) patients completed the study protocol and were included for statistical analysis. The NMSS total domains score in the PSP group was 77.58 ± 42.95 (range 14–163) with NMS burden grade: 4, very severe, and the in the PD group was 41.97 ± 35.45 (range: 0–215) with NMS burden grade: 3, severe. The comparative analysis showed that NMS total score (p < 0.0001), Sleep/Fatigue (p = 0.0007), Mood/Apathy (p = 0.0001), Gastrointestinal (p < 0.0001), and Urinary dysfunction (p = 0.0001) domains were significantly more severe in PSP patients than in PD. This observational study reports that NMSs are very frequent in PSP patients hence the higher burden of NMS in PSP specifically related to mood/apathy, attention/memory, gastrointestinal, urinary disturbances compared to PD. Non-motor symptoms are more frequent and severe in patients with Progressive Supranuclear Palsy (PSP) than in those with Parkinson’s disease (PD). An international team led by Fabrizio Stocchi at the Institute for Research and Medical Care IRCCS in Rome used the Non-motor Symptoms Scale (NMSS) to compare the symptoms experienced by 50 PSP patients and 100 PD patients. They found that patients with PSP suffered worse and more frequent gastrointestinal and urinary disturbances, as well as more severe dysfunctions in attention and memory compared with PD patients. Moreover, the reported lack of motivation and sleep disturbances were more burdensome in PSP patients. These findings will not only contribute to diagnose PSP earlier and more accurately, but also help to increase awareness of the impact of non-motor symptoms on patients’ quality of life.
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Affiliation(s)
| | | | - Chiara Fossati
- Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy
| | | | - Margherita Torti
- Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy
| | | | - Laura Vacca
- Department of Neuro-rehabilitation Sciences, Casa Cura Policlinico (CCP), Milan, Italy
| | - Fabrizio Stocchi
- Institute for Research and Medical Care IRCCS San Raffaele, Rome, Italy
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29
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Cosseddu M, Benussi A, Gazzina S, Manes MA, Dell'Era V, Cristillo V, Turrone R, Alberici A, Borroni B. Natural history and predictors of survival in progressive supranuclear palsy. J Neurol Sci 2017; 382:105-107. [DOI: 10.1016/j.jns.2017.09.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/12/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
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30
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Miller N, Nath U, Noble E, Burn D. Utility and accuracy of perceptual voice and speech distinctions in the diagnosis of Parkinson’s disease, PSP and MSA-P. Neurodegener Dis Manag 2017. [DOI: 10.2217/nmt-2017-0005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: To determine if perceptual speech measures distinguish people with Parkinson’s disease (PD), multiple system atrophy with predominant parkinsonism (MSA-P) and progressive supranuclear palsy (PSP). Methods: Speech–language therapists blind to patient characteristics employed clinical rating scales to evaluate speech/voice in 24 people with clinically diagnosed PD, 17 with PSP and 9 with MSA-P, matched for disease duration (mean 4.9 years, standard deviation 2.2). Results: No consistent intergroup differences appeared on specific speech/voice variables. People with PD were significantly less impaired on overall speech/voice severity. Analyses by severity suggested further investigation around laryngeal, resonance and fluency changes may characterize individual groups. Conclusion: MSA-P and PSP compared with PD were distinguished by severity of speech/voice deterioration, but individual speech/voice parameters failed to consistently differentiate groups.
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Affiliation(s)
- Nick Miller
- Newcastle University Institute for Ageing, Speech & Language Sciences, George VI Building, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Uma Nath
- Consultant Neurologist, Sunderland Royal Hospital, Kyall Road, Sunderland SR4 7TP, UK
| | - Emma Noble
- Newcastle University Institute for Ageing, Speech & Language Sciences, George VI Building, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - David Burn
- Institute of Neuroscience, Professor of Movement Disorders Neurology, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
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31
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Levytskyy RM, Germany EM, Khalimonchuk O. Mitochondrial Quality Control Proteases in Neuronal Welfare. J Neuroimmune Pharmacol 2016; 11:629-644. [PMID: 27137937 PMCID: PMC5093085 DOI: 10.1007/s11481-016-9683-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/27/2016] [Indexed: 01/01/2023]
Abstract
The functional integrity of mitochondria is a critical determinant of neuronal health and compromised mitochondrial function is a commonly recognized factor that underlies a plethora of neurological and neurodegenerative diseases. Metabolic demands of neural cells require high bioenergetic outputs that are often associated with enhanced production of reactive oxygen species. Unopposed accumulation of these respiratory byproducts over time leads to oxidative damage and imbalanced protein homeostasis within mitochondrial subcompartments, which in turn may result in cellular demise. The post-mitotic nature of neurons and their vulnerability to these stress factors necessitate strict protein homeostatic control to prevent such scenarios. A series of evolutionarily conserved proteases is one of the central elements of mitochondrial quality control. These versatile proteolytic enzymes conduct a multitude of activities to preserve normal mitochondrial function during organelle biogenesis, metabolic remodeling and stress. In this review we discuss neuroprotective aspects of mitochondrial quality control proteases and neuropathological manifestations arising from defective proteolysis within the mitochondrion.
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Affiliation(s)
- Roman M Levytskyy
- Department of Biochemistry, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Edward M Germany
- Department of Biochemistry, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Oleh Khalimonchuk
- Department of Biochemistry, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA.
- Nebraska Redox Biology Center, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA.
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32
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Uchihara T. An order in Lewy body disorders: Retrograde degeneration in hyperbranching axons as a fundamental structural template accounting for focal/multifocal Lewy body disease. Neuropathology 2016; 37:129-149. [DOI: 10.1111/neup.12348] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Toshiki Uchihara
- Laboratory of Structural Neuropathology; Tokyo Metropolitan Institute of Medical Science; 2-1-6 Kamikitazawa, Setagaya Tokyo Japan
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33
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Robertson EE, Hall DA, McAsey AR, O'Keefe JA. Fragile X-associated tremor/ataxia syndrome: phenotypic comparisons with other movement disorders. Clin Neuropsychol 2016; 30:849-900. [PMID: 27414076 PMCID: PMC7336900 DOI: 10.1080/13854046.2016.1202239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/12/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this paper is to review the typical cognitive and motor impairments seen in fragile X-associated tremor/ataxia syndrome (FXTAS), essential tremor (ET), Parkinson disease (PD), spinocerebellar ataxias (SCAs), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP) in order to enhance diagnosis of FXTAS patients. METHODS We compared the cognitive and motor phenotypes of FXTAS with each of these other movement disorders. Relevant neuropathological and neuroimaging findings are also reviewed. Finally, we describe the differences in age of onset, disease severity, progression rates, and average lifespan in FXTAS compared to ET, PD, SCAs, MSA, and PSP. We conclude with a flow chart algorithm to guide the clinician in the differential diagnosis of FXTAS. RESULTS By comparing the cognitive and motor phenotypes of FXTAS with the phenotypes of ET, PD, SCAs, MSA, and PSP we have clarified potential symptom overlap while elucidating factors that make these disorders unique from one another. In summary, the clinician should consider a FXTAS diagnosis and testing for the Fragile X mental retardation 1 (FMR1) gene premutation if a patient over the age of 50 (1) presents with cerebellar ataxia and/or intention tremor with mild parkinsonism, (2) has the middle cerebellar peduncle (MCP) sign, global cerebellar and cerebral atrophy, and/or subcortical white matter lesions on MRI, or (3) has a family history of fragile X related disorders, intellectual disability, autism, premature ovarian failure and has neurological signs consistent with FXTAS. Peripheral neuropathy, executive function deficits, anxiety, or depression are supportive of the diagnosis. CONCLUSIONS Distinct profiles in the cognitive and motor domains between these movement disorders may guide practitioners in the differential diagnosis process and ultimately lead to better medical management of FXTAS patients.
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Affiliation(s)
- Erin E Robertson
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
| | - Deborah A Hall
- b Department of Neurological Sciences , Rush University , Chicago , IL , USA
| | - Andrew R McAsey
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
| | - Joan A O'Keefe
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
- b Department of Neurological Sciences , Rush University , Chicago , IL , USA
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Abstract
Progressive supranuclear palsy (PSP) is an atypical parkinsonian condition characterized by a symmetric akinetic-rigid syndrome, early falls, supranuclear gaze palsy, and a frontotemporal behavioral syndrome. The typical phenotype is termed Richardson's syndrome, but numerous other phenotypes have been described. The pathophysiology of PSP is not fully understood, but dysfunction of the tau protein seems to play a central role. Despite exciting new knowledge on the pathophysiology of PSP, there is still no highly effective symptomatic or disease-modifying treatment. We review the evidence on pharmacotherapy and experimental therapies in PSP and provide levels of recommendation for the off-label use of commonly used drugs in this disorder.
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