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Santos Silva C, Gormicho M, Simão S, Pronto-Laborinho AC, Alves I, Pinto S, Oliveira Santos M, de Carvalho M. C9orf72 gene repeat expansion phenotype profile of motor neurone disease in Portugal. J Neurol Sci 2024; 465:123208. [PMID: 39226712 DOI: 10.1016/j.jns.2024.123208] [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: 05/20/2024] [Revised: 07/18/2024] [Accepted: 08/29/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND C9orf72 gene repeat expansion (C9RE) is the most frequent gene variant associated with amyotrophic lateral sclerosis (ALS). We aimed to study the phenotype of motor neurone disease (MND) patients with C9RE in a Portuguese cohort. METHODS Demographical and clinical data of MND patients with (C9RE+) and without C9RE were compared. ALS al Rating Scale-Revised (ALSFRS-R) and Edinburgh Cognitive and Behavioural ALS Screen (ECAS) were used to evaluate functional and cognitive performance, respectively. Survival analysis was performed using Kaplan Meier log-rank test and Cox proportional hazards model. RESULTS We included 761 patients of whom 61 (8.0 %) were C9RE+. C9RE+ patients had a higher frequency of ALS (95.1 vs 78.4 %, p = 0.002), and lower frequency of progressive muscular atrophy (3.3 vs 16.7 %, p = 0.006). C9RE+ was associated with earlier age of onset (58.1 vs 62.6 years, p = 0.003) and more frequent MND family history (65.5 vs 11.4 %, p < 0.001). Gender, ethnicity, onset site, diagnostic delay, disease progression rate until diagnosis (ΔF), ALSFRS-R and time until non-invasive ventilation did not differ between groups. Cognitive/behavioural symptoms and ECAS did not differ between groups, except a worse visuospatial score in C9RE+ group (p = 0.035). Death rate was 1.8 and 1.6 times higher in C9RE+ patients with MND and ALS, respectively. Significant survival prognostic factors in C9RE+ group were diagnosis delay (HR = 0.96, 95 %CI 0.92-0.99, p = 0.008) and ΔF (HR = 1.93, 95 %CI 1.26-2.96, p = 0.002). CONCLUSION Our study corroborates most previous cohorts' findings, but harbours some singularities regarding onset site, phenotype, and cognitive profile, that contribute to a better understanding of C9RE epidemiology.
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Affiliation(s)
- Cláudia Santos Silva
- Department of Neurosciences and Mental Health, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal; Faculdade de Medicina-Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Universidade de Lisboa, Lisboa, Portugal.
| | - Marta Gormicho
- Faculdade de Medicina-Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Universidade de Lisboa, Lisboa, Portugal
| | - Sara Simão
- Faculdade de Medicina-Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Catarina Pronto-Laborinho
- Faculdade de Medicina-Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Universidade de Lisboa, Lisboa, Portugal
| | - Inês Alves
- Faculdade de Medicina-Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Universidade de Lisboa, Lisboa, Portugal
| | - Susana Pinto
- Faculdade de Medicina-Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel Oliveira Santos
- Department of Neurosciences and Mental Health, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal; Faculdade de Medicina-Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Universidade de Lisboa, Lisboa, Portugal
| | - Mamede de Carvalho
- Department of Neurosciences and Mental Health, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal; Faculdade de Medicina-Instituto de Medicina Molecular, Centro de Estudos Egas Moniz, Universidade de Lisboa, Lisboa, Portugal
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Olsen CG, Malmberg VN, Fahlström M, Alstadhaug KB, Bjørnå IK, Braathen GJ, Bråthen G, Demic N, Hallerstig E, Hogenesch I, Horn MA, Kampman MT, Kleveland G, Ljøstad U, Maniaol A, Morsund ÅH, Nakken O, Schlüter K, Schuler S, Seim E, Flemmen HØ, Tysnes OB, Holmøy T, Høyer H. Amyotrophic lateral sclerosis caused by the C9orf72 expansion in Norway - prevalence, ancestry, clinical characteristics and sociodemographic status. Amyotroph Lateral Scler Frontotemporal Degener 2024:1-9. [PMID: 39316038 DOI: 10.1080/21678421.2024.2405118] [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: 07/02/2024] [Revised: 09/03/2024] [Accepted: 09/12/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVE The most common genetic cause of amyotrophic lateral sclerosis (ALS) is the C9orf72 expansion. A high incidence of this expansion has been detected in Sweden and Finland. This Norwegian population-based study aimed to identify the prevalence, geographic distribution, ancestry, and relatedness of ALS patients with a C9orf72 expansion (C9pos). Further, we compared C9pos and C9neg patients' clinical presentation, family history of ALS and other neurodegenerative disorders, and sociodemographic status. METHODS We recruited ALS patients from all 17 Departments of neurology in Norway. Blood samples and questionnaires regarding clinical characteristics, sociodemographic status and family history of ALS, and other neurodegenerative disorders were collected. The C9orf72 expansion was examined for all patients. RESULTS The study enrolled 500 ALS patients, 8.8% of whom were C9pos, with half being sporadic ALS cases. The proportion of C9pos cases differed between regions, ranging from 17.9% in the Northern region to 1.9% in the Western region. The majority of C9pos patients had non-Finnish European descent and were not closely related. C9pos patients exhibited a significantly shorter mean survival time, had a higher frequency of relatives with ALS or dementia, and were more often unmarried/single and childless than C9neg patients. CONCLUSION C9pos patients constitute a large portion of the Norwegian ALS population. Ancestry and relatedness do not adequately explain regional differences. Relying on clinical information to identify C9pos patients has proven to be challenging. Half of C9pos patients were reported as having sporadic ALS, underlining the importance of carefully assessing family history and the need for genetic testing.
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Affiliation(s)
- Cathrine Goberg Olsen
- Department of Medical Genetics, Telemark Hospital Trust, Skien, Norway
- Institute of Clinical Medicine, University of Oslo, Nordbyhagen, Norway
| | - Vetle Nilsen Malmberg
- Institute of Clinical Medicine, University of Oslo, Nordbyhagen, Norway
- Department of Neurology, Telemark Hospital Trust, Skien, Norway
| | - Maria Fahlström
- Department of Medical Genetics, Telemark Hospital Trust, Skien, Norway
| | | | | | | | - Geir Bråthen
- Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Natasha Demic
- Department of Neurology, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Ineke Hogenesch
- Department of Neurology, Fonna Hospital Trust, Haugesund, Norway
| | | | - Margitta T Kampman
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Grethe Kleveland
- Department of Neurology, Innlandet Hospital Trust, Lillehammer, Norway
| | - Unn Ljøstad
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | | | - Åse Hagen Morsund
- Department of Neurology, Møre og Romsdal Hospital Trust, Molde, Norway
| | - Ola Nakken
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Katrin Schlüter
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Stephan Schuler
- Department of Neurology, Nord-Trøndelag Hospital Trust, Namsos, Norway
| | - Elin Seim
- Department of Neurology, Førde Hospital Trust, Førde, Norway, and
| | | | - Ole-Bjørn Tysnes
- Department of Clinical Medicine, University of Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Trygve Holmøy
- Institute of Clinical Medicine, University of Oslo, Nordbyhagen, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Helle Høyer
- Department of Medical Genetics, Telemark Hospital Trust, Skien, Norway
- Institute of Clinical Medicine, University of Oslo, Nordbyhagen, Norway
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Simão S, Oliveira Santos M, Gromicho M, Pavão Martins I, De Carvalho M. Cognitive reserve as a modulator of cognitive decline and of behavioral symptoms in patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2024:1-11. [PMID: 39101689 DOI: 10.1080/21678421.2024.2385684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
Introduction: Amyotrophic lateral sclerosis (ALS) has heterogeneous manifestations ranging from motor neuron degeneration to cognitive and behavioral impairment. This study aims to clarify the interactions between cognition and behavioral symptoms with relevant disease predictors and with cognitive reserve (CR), quantified through education, physical activity, and occupation proxies. Methods: A prospective sample of 162 ALS patients and 61 controls were evaluated with the Edinburgh Cognitive and Behavioral ALS Screen (ECAS) (dependent variable), a Cognitive Reserve Index questionnaire (CRIq) and demographic data (age and sex), and, for patients, clinical variables: disease duration, site of onset, the ALS Functional Rating Scale (ALSFRS), forced vital capacity (FVC), and gene mutation chromosome 9 open reading frame 72 (C9orf72) (independent variables). Multiple regression and mediation analyses were performed to predict cognitive and behavioral symptoms. Results: For the ALS group, the statistical model explained 38.8% of variance in ECAS total (p < 0.001), 59.4% of executive functions (p < 0.001), and 55% of behavioral symptoms (p < 0.001). For controls, it accounted for 52.8% of variance in ECAS total (p < 0.001). Interaction effects and mediation analysis showed CR is an ECAS total modulator, with a differential effect within groups (p < 0.001). Verbal fluency was the single best cognitive score to differentiate patients from controls (p = 0.004), and the gene mutation C9orf72 was found to be a behavioral symptom' predictor in patients (p = 0.009). Conclusion: This study supports the proposed concept that CR acts as a cognitive modulator in ALS patients and healthy individuals. Moreover, CR also modulates behavioral manifestations in ALS.
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Affiliation(s)
- Sara Simão
- Faculty of Medicine, Institute of Molecular Medicine, University of Lisbon, Lisbon, Portugal
| | - Miguel Oliveira Santos
- Faculty of Medicine, Institute of Molecular Medicine, University of Lisbon, Lisbon, Portugal
- Faculty of Medicine, Centre of Studies Egas Moniz, University of Lisbon, Lisbon, Portugal, and
| | - Marta Gromicho
- Faculty of Medicine, Institute of Molecular Medicine, University of Lisbon, Lisbon, Portugal
| | - Isabel Pavão Martins
- Faculty of Medicine, Centre of Studies Egas Moniz, University of Lisbon, Lisbon, Portugal, and
- Department of Neurosciences and Mental Health, Hospital (ULS) de Santa Maria, Lisbon, Portugal
| | - Mamede De Carvalho
- Faculty of Medicine, Institute of Molecular Medicine, University of Lisbon, Lisbon, Portugal
- Faculty of Medicine, Centre of Studies Egas Moniz, University of Lisbon, Lisbon, Portugal, and
- Department of Neurosciences and Mental Health, Hospital (ULS) de Santa Maria, Lisbon, Portugal
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Calvo A, Moglia C, Canosa A, Manera U, Vasta R, Grassano M, Daviddi M, De Mattei F, Matteoni E, Gallone S, Brunetti M, Sbaiz L, Cabras S, Peotta L, Palumbo F, Iazzolino B, Mora G, Chiò A. High Frequency of Cognitive and Behavioral Impairment in Amyotrophic Lateral Sclerosis Patients with SOD1 Pathogenic Variants. Ann Neurol 2024; 96:150-158. [PMID: 38568044 DOI: 10.1002/ana.26928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE While the cognitive-behavioral characteristics of amyotrophic lateral sclerosis (ALS) patients carrying C9orf72 pathological repeat expansion have been extensively studied, our understanding of those carrying SOD1 variants is mostly based on case reports. The aim of this paper is to extensively explore the cognitive-behavioral characteristics of a cohort of ALS patients carrying pathogenetic variants of SOD1 gene, comparing them to patients without pathogenetic variants of 46 ALS-related genes (wild-type [WT]-ALS) and healthy controls. METHODS All ALS patients seen at the Turin ALS expert center in the 2009-2021 period who underwent both cognitive/behavioral and extensive genetic testing were eligible to be included in the study. Only patients with SOD1 pathogenetic variants (n = 28) (SOD1-ALS) and WT-ALS (n = 829) were enrolled in the study. A series of 129 controls was also included. RESULTS Among the 28 SOD1-ALS patients, 16 (57.1%) had normal cognitive function, 5 (17.9%) isolated cognitive impairment (ALSci) (17.9%), 6 (21.4%) isolated behavioral impairment (ALSbi), 1 (3.6%) cognitive and behavioral impairment (ALScbi), and no one ALS-FTD. SOD1-ALS performed worse than controls in all explored domains, in particular Social Cognition and Language domains. SOD1-ALS patients had similar scores in all tests compared to WT-ALS, except the Story-based Empathy Task (SET), where they performed worse. INTERPRETATION Cognitive-behavioral impairment is much more common in SOD1 patients than previously assumed. SOD1-ALS are characterized by a more frequent impairment of Social Cognition and, less markedly, of Language domains. These findings have relevant implication both in the clinical and in the research setting, also considering recently approved treatment for SOD1-ALS. ANN NEUROL 2024;96:150-158.
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Affiliation(s)
- Andrea Calvo
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
- Neurology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
| | - Cristina Moglia
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
- Neurology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
| | - Antonio Canosa
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
- Neurology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
| | - Umberto Manera
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
- Neurology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
| | - Rosario Vasta
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
| | - Maurizio Grassano
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
| | - Margherita Daviddi
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
| | - Filippo De Mattei
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
| | - Enrico Matteoni
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
| | - Salvatore Gallone
- Neurology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
| | - Maura Brunetti
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
| | - Luca Sbaiz
- Neurology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
| | - Sara Cabras
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
| | - Laura Peotta
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
| | - Francesca Palumbo
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
| | - Barbara Iazzolino
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
| | - Gabriele Mora
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
| | - Adriano Chiò
- ALS Center, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino, Turin, Italy
- Neurology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
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Riva N, Domi T, Pozzi L, Lunetta C, Schito P, Spinelli EG, Cabras S, Matteoni E, Consonni M, Bella ED, Agosta F, Filippi M, Calvo A, Quattrini A. Update on recent advances in amyotrophic lateral sclerosis. J Neurol 2024; 271:4693-4723. [PMID: 38802624 PMCID: PMC11233360 DOI: 10.1007/s00415-024-12435-9] [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: 04/09/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
In the last few years, our understanding of disease molecular mechanisms underpinning ALS has advanced greatly, allowing the first steps in translating into clinical practice novel research findings, including gene therapy approaches. Similarly, the recent advent of assistive technologies has greatly improved the possibility of a more personalized approach to supportive and symptomatic care, in the context of an increasingly complex multidisciplinary line of actions, which remains the cornerstone of ALS management. Against this rapidly growing background, here we provide an comprehensive update on the most recent studies that have contributed towards our understanding of ALS pathogenesis, the latest results from clinical trials as well as the future directions for improving the clinical management of ALS patients.
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Affiliation(s)
- Nilo Riva
- 3Rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS "Carlo Besta" Neurological Insitute, Milan, Italy.
| | - Teuta Domi
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Pozzi
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Christian Lunetta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Milan Institute, 20138, Milan, Italy
| | - Paride Schito
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Edoardo Gioele Spinelli
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Cabras
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin; SC Neurologia 1U, AOU città della Salute e della Scienza di Torino, Turin, Italy
| | - Enrico Matteoni
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin; SC Neurologia 1U, AOU città della Salute e della Scienza di Torino, Turin, Italy
| | - Monica Consonni
- 3Rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS "Carlo Besta" Neurological Insitute, Milan, Italy
| | - Eleonora Dalla Bella
- 3Rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS "Carlo Besta" Neurological Insitute, Milan, Italy
| | - Federica Agosta
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute Huniversity, Milan, Italy
| | - Massimo Filippi
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute Huniversity, Milan, Italy
| | - Andrea Calvo
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin; SC Neurologia 1U, AOU città della Salute e della Scienza di Torino, Turin, Italy
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Sellier C, Corcia P, Vourc'h P, Dupuis L. C9ORF72 hexanucleotide repeat expansion: From ALS and FTD to a broader pathogenic role? Rev Neurol (Paris) 2024; 180:417-428. [PMID: 38609750 DOI: 10.1016/j.neurol.2024.03.008] [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: 03/20/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024]
Abstract
The major gene underlying monogenic forms of amyotrophic lateral sclerosis (ALS) and fronto-temporal dementia (FTD) is C9ORF72. The causative mutation in C9ORF72 is an abnormal hexanucleotide (G4C2) repeat expansion (HRE) located in the first intron of the gene. The aim of this review is to propose a comprehensive update on recent developments on clinical, biological and therapeutics aspects related to C9ORF72 in order to highlight the current understanding of genotype-phenotype correlations, and also on biological machinery leading to neuronal death. We will particularly focus on the broad phenotypic presentation of C9ORF72-related diseases, that goes well beyond the classical phenotypes observed in ALS and FTD patients. Last, we will comment the possible therapeutical hopes for patients carrying a C9ORF72 HRE.
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Affiliation(s)
- C Sellier
- Centre de recherches en biomédecine de Strasbourg, UMR-S1329, Inserm, université de Strasbourg, Strasbourg, France
| | - P Corcia
- UMR 1253 iBrain, Inserm, université de Tours, Tours, France; Centre constitutif de coordination SLA, CHU de Bretonneau, 2, boulevard Tonnelle, 37044 Tours cedex 1, France
| | - P Vourc'h
- UMR 1253 iBrain, Inserm, université de Tours, Tours, France; Service de biochimie et biologie moléculaire, CHU de Tours, Tours, France
| | - L Dupuis
- Centre de recherches en biomédecine de Strasbourg, UMR-S1329, Inserm, université de Strasbourg, Strasbourg, France.
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Moglia C, Calvo A, Canosa A, Manera U, Vasta R, Di Pede F, Daviddi M, Matteoni E, Brunetti M, Sbaiz L, Cabras S, Gallone S, Grassano M, Peotta L, Palumbo F, Mora G, Iazzolino B, Chio A. Cognitive and Behavioral Features of Patients With Amyotrophic Lateral Sclerosis Who Are Carriers of the TARDBP Pathogenic Variant. Neurology 2024; 102:e208082. [PMID: 38261982 PMCID: PMC10962913 DOI: 10.1212/wnl.0000000000208082] [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: 08/28/2023] [Accepted: 10/26/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES TARDBP patients are considered particularly prone to cognitive involvement, but no systematic studies of cognitive impairment in TARDBP patients are available. The aim of this article was to depict in depth the cognitive-behavioral characteristics of a cohort of patients with amyotrophic lateral sclerosis (ALS) carrying TARDBP pathogenetic variants followed by an ALS referral center. METHODS We enrolled all patients with ALS seen at the Turin ALS expert center in the 2009-2021 period who underwent extensive genetic testing and a neuropsychological battery encompassing executive function, verbal memory, language, visual memory, visuoconstructive abilities, attention/working memory, psychomotor speed, nonverbal intelligence, cognitive flexibility, social cognition, and behavior. Tests were compared with the Mann-Whitney U test on age-corrected, sex-corrected, and education-corrected scores. Cognition was classified as normal (ALS-CN); isolated cognitive impairment (ALSci), that is, evidence of executive and/or language dysfunction; isolated behavioral impairment (ALSbi), that is, identification of apathy; cognitive and behavioral impairment (ALScbi), that is, evidence meeting the criteria for both ALSci and ALSbi; and frontotemporal dementia (ALS-FTD). RESULTS This study includes 33 patients with TARDBP pathogenetic variants (TARDBP-ALS) (median age 61 years [interquartile range (IQR) 53-67], 8 female [24.2%]) and 928 patients with ALS not carrying the pathogenic variant (WT-ALS) (median age 67 years [IQR 59-74], 386 female [41.6%]). TARDBP-ALS cases were also compared with 129 matched controls (median age 66 years [IQR 57.5-71.5], 55 female [42.6%]). TARDBP-ALS and WT-ALS patients were cognitively classified as ALS-CN (54% vs 58.8%, respectively), ALSci (21.2% vs 18.3%), ALSci (9.1% vs 9.5%), ALScbi (6.1% vs 6.0%), and ALS-FTD (9.1 vs 6.7%), with no significant difference (p = 0.623). Compared with controls, TARDBP-ALS had a worse performance in executive functions, visual memory, visuoconstructive abilities, verbal fluency, and the apathy behavioral component of FrSBe. The scores of performed tests, including all Edinburgh Cognitive and Behavioral ALS Screen subdomains, were similar in TARDBP-ALS and WT-ALS. DISCUSSION TARDBP-ALS patients were significantly more impaired than controls in most examined domains but do not show any specific pattern of cognitive impairment compared with WT-ALS. Our findings are relevant both clinically, considering the effect of cognitive impairment on patients' decision-making and caregivers' burden, and in designing clinical trials for the treatment of patients carrying TARDBP pathogenetic variants.
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Affiliation(s)
- Cristina Moglia
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Andrea Calvo
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Antonio Canosa
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Umberto Manera
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Rosario Vasta
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Francesca Di Pede
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Margherita Daviddi
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Enrico Matteoni
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Maura Brunetti
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Luca Sbaiz
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Sara Cabras
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Salvatore Gallone
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Maurizio Grassano
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Laura Peotta
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Francesca Palumbo
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Gabriele Mora
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Barbara Iazzolino
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
| | - Adriano Chio
- From the Rita Levi Montalcini' Department of Neuroscience (C.M., A. Calvo, A. Canosa, U.M., R.V., F.D.P., M.D., E.M., M.B., S.C., M.G., L.P., F.F.P., G.M., B.I., A. Chio), University of Torino; Neurology 1 (C.M., A. Calvo, A. Canosa, U.M., L.S., S.G., A. Chio), Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino; and Institute of Cognitive Sciences and Technologies (A. Canosa, A. Chio), National Research Council, Rome, Italy
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8
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Gentile F, Maranzano A, Verde F, Bettoni V, Colombo E, Doretti A, Olivero M, Scheveger F, Colombrita C, Bulgarelli I, Spinelli EG, Torresani E, Messina S, Maderna L, Agosta F, Morelli C, Filippi M, Silani V, Ticozzi N. The value of routine blood work-up in clinical stratification and prognosis of patients with amyotrophic lateral sclerosis. J Neurol 2024; 271:794-803. [PMID: 37801095 PMCID: PMC10827966 DOI: 10.1007/s00415-023-12015-3] [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: 07/19/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND There is an unmet need in amyotrophic lateral sclerosis (ALS) to provide specific biomarkers for the disease. Due to their easy availability, we aimed to investigate whether routine blood parameters provide useful clues for phenotypic classification and disease prognosis. METHODS We analyzed a large inpatient cohort of 836 ALS patients who underwent deep phenotyping with evaluation of the clinical and neurophysiological burden of upper (UMN) and lower (LMN) motor neuron signs. Disability and progression rate were measured through the revised ALS Functional Rating Scale (ALSFRS-R) and its changes during time. Cox regression analysis was performed to assess survival associations. RESULTS Creatinine significantly correlated with LMN damage (r = 0.38), active (r = 0.18) and chronic (r = 0.24) denervation and baseline ALSFRS-R (r = 0.33). Creatine kinase (CK), alanine (ALT) and aspartate (AST) transaminases correlated with active (r = 0.35, r = 0.27, r = 0.24) and chronic (r = 0.37, r = 0.20, r = 0.19) denervation, while albumin and C-reactive protein significantly correlated with LMN score (r = 0.20 and r = 0.17). Disease progression rate showed correlations with chloride (r = -0.19) and potassium levels (r = -0.16). After adjustment for known prognostic factors, total protein [HR 0.70 (95% CI 0.57-0.86)], creatinine [HR 0.86 (95% CI 0.81-0.92)], chloride [HR 0.95 (95% CI 0.92-0.99)], lactate dehydrogenase [HR 0.99 (95% CI 0.99-0.99)], and AST [HR 1.02 (95% CI 1.01-1.02)] were independently associated with survival. CONCLUSIONS Creatinine is a reliable biomarker for ALS, associated with clinical features, disability and survival. Markers of nutrition/inflammation may offer additional prognostic information and partially correlate with clinical features. AST and chloride could further assist in predicting progression rate and survival.
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Affiliation(s)
- Francesco Gentile
- Neurology Residency Program, Università degli Studi di Milano, Milan, Italy
| | - Alessio Maranzano
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Federico Verde
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Veronica Bettoni
- Department of Brain and Behavioral Sciences, IRCCS Mondino Foundation, Università degli Studi di Pavia, Pavia, Italy
| | - Eleonora Colombo
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Alberto Doretti
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Marco Olivero
- Neurology Residency Program, Università degli Studi di Milano, Milan, Italy
| | | | - Claudia Colombrita
- Department of Laboratory Medicine, Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Ilaria Bulgarelli
- Department of Laboratory Medicine, Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Edoardo Gioele Spinelli
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Erminio Torresani
- Department of Laboratory Medicine, Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefano Messina
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Luca Maderna
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Federica Agosta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Claudia Morelli
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology, IRCCS Istituto Auxologico Italiano, P. Le Brescia 20, 20149, Milan, Italy.
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy.
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9
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Jellinger KA. Understanding depression with amyotrophic lateral sclerosis: a short assessment of facts and perceptions. J Neural Transm (Vienna) 2024; 131:107-115. [PMID: 37922093 DOI: 10.1007/s00702-023-02714-6] [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: 09/14/2023] [Accepted: 10/19/2023] [Indexed: 11/05/2023]
Abstract
Depression with an average prevalence of 25-40% is a serious condition in amyotrophic lateral sclerosis (ALS) that can impact quality of life and survival of patients and caregiver burden, yet the underlying neurobiology is poorly understood. Preexisting depression has been associated with a higher risk of developing ALS, while people with ALS have a significantly higher risk of developing depression that can cause multiple complications. Depression may be a prodromal or subclinical symptom prior to motor involvement, although its relations with disease progression and impairment of quality of life are under discussion. Unfortunately, there are no studies existing that explore the pathogenic mechanisms of depression associated with the basic neurodegenerative process, and no specific neuroimaging data or postmortem findings for the combination of ALS and depression are currently available. Experience from other neurodegenerative processes suggests that depressive symptoms in ALS may be the consequence of cortical thinning in prefrontal regions and other cortex areas, disruption of mood-related brain networks, dysfunction of neurotransmitter systems, changing cortisol levels and other, hitherto unknown mechanisms. Treatment of both ALS and depression is a multidisciplinary task, depression generally being treated with a combination of antidepressant medication, physiotherapy, psychological and other interventions, while electroconvulsive therapy and deep brain stimulation might not be indicated in the majority of patients in view of their poor prognosis. Since compared to depression in other neurodegenerative diseases, our knowledge of its molecular basis in ALS is missing, multidisciplinary clinicopathological studies to elucidate the pathomechanism of depression in motor system disorders including ALS are urgently warranted.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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10
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White LM, Boardman J, Lilleker J, Chaouch A, Kargwell H, Ealing J, Hamdalla H. Phenotypical differences of C9ORF72 gene-positive and negative amyotrophic lateral sclerosis: a comparative case series. J Med Genet 2023; 60:1016-1020. [PMID: 37173134 DOI: 10.1136/jmg-2022-109016] [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: 10/28/2022] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Hexanucleotide repeat expansions of C9ORF72 account for a significant proportion of autosomal dominant neurodegenerative diseases in the amyotrophic lateral sclerosis (ALS)-frontotemporal dementia spectrum. In the absence of a family history, clinical identification of such patients remains difficult. We aimed to identify differences in demographics and clinical presentation between patients with C9ORF72 gene-positive ALS (C9pALS) versus C9ORF72 gene-negative ALS (C9nALS), to aid identification of these patients in the clinic and examine differences in outcomes including survival. METHODS We retrospectively reviewed the clinical presentations of 32 patients with C9pALS and compared their characteristics with a cohort of 46 patients with C9nALS from the same tertiary neurosciences centre. RESULTS Patients with C9pALS more commonly presented with mixed upper and lower motor signs (C9pALS 87.5%, C9nALS 65.2%; p=0.0352), but less frequently presented with purely upper motor neuron signs (C9pALS 3.1%, C9nALS 21.7%; p=0.0226). The C9pALS cohort had a higher frequency of cognitive impairment (C9pALS 31.3%, C9nALS 10.9%; p=0.0394) and bulbar disease (C9pALS 56.3%, C9nALS 28.3%; p=0.0186). There were no differences between cohorts in age at diagnosis, gender, limb weakness, respiratory symptoms, presentation with predominantly lower motor neuron signs or overall survival. DISCUSSION Analysis of this ALS clinic cohort at a UK tertiary neurosciences centre adds to the small but growing understanding of the unique clinical features of patients with C9pALS. In the age of precision medicine with expanding opportunities to manage genetic diseases with disease-modifying therapies, clinical identification of such patients is increasingly important as focused therapeutic strategies become available.
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Affiliation(s)
- Laura Michelle White
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Salford, UK
| | | | - James Lilleker
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Salford, UK
- Centre for Musculoskeletal Research, The University of Manchester School of Biological Sciences, Manchester, UK
| | - Amina Chaouch
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Salford, UK
| | - Haga Kargwell
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Salford, UK
| | - John Ealing
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Salford, UK
| | - Hisham Hamdalla
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Salford, UK
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11
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Jellinger KA. The Spectrum of Cognitive Dysfunction in Amyotrophic Lateral Sclerosis: An Update. Int J Mol Sci 2023; 24:14647. [PMID: 37834094 PMCID: PMC10572320 DOI: 10.3390/ijms241914647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Cognitive dysfunction is an important non-motor symptom in amyotrophic lateral sclerosis (ALS) that has a negative impact on survival and caregiver burden. It shows a wide spectrum ranging from subjective cognitive decline to frontotemporal dementia (FTD) and covers various cognitive domains, mainly executive/attention, language and verbal memory deficits. The frequency of cognitive impairment across the different ALS phenotypes ranges from 30% to 75%, with up to 45% fulfilling the criteria of FTD. Significant genetic, clinical, and pathological heterogeneity reflects deficits in various cognitive domains. Modern neuroimaging studies revealed frontotemporal degeneration and widespread involvement of limbic and white matter systems, with hypometabolism of the relevant areas. Morphological substrates are frontotemporal and hippocampal atrophy with synaptic loss, associated with TDP-43 and other co-pathologies, including tau deposition. Widespread functional disruptions of motor and extramotor networks, as well as of frontoparietal, frontostriatal and other connectivities, are markers for cognitive deficits in ALS. Cognitive reserve may moderate the effect of brain damage but is not protective against cognitive decline. The natural history of cognitive dysfunction in ALS and its relationship to FTD are not fully understood, although there is an overlap between the ALS variants and ALS-related frontotemporal syndromes, suggesting a differential vulnerability of motor and non-motor networks. An assessment of risks or the early detection of brain connectivity signatures before structural changes may be helpful in investigating the pathophysiological mechanisms of cognitive impairment in ALS, which might even serve as novel targets for effective disease-modifying therapies.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150 Vienna, Austria
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12
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Aiello EN, Solca F, Torre S, Patisso V, De Lorenzo A, Treddenti M, Colombo E, Maranzano A, Morelli C, Doretti A, Verde F, Silani V, Ticozzi N, Poletti B. Bulbar involvement and cognitive features in amyotrophic lateral sclerosis: a retrospective study on 347 patients. Front Aging Neurosci 2023; 15:1217080. [PMID: 37547740 PMCID: PMC10399238 DOI: 10.3389/fnagi.2023.1217080] [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: 05/04/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Background This study aimed at clarifying the role of bulbar involvement (BI) as a risk factor for cognitive impairment (CI) in non-demented amyotrophic lateral sclerosis (ALS) patients. Methods Data on N = 347 patients were retrospectively collected. Cognition was assessed via the Edinburgh Cognitive and Behavioral ALS Screen (ECAS). On the basis of clinical records and ALS Functional Rating Scale-Revised (ALSFRS-R) scores, BI was characterized as follows: (1) BI at onset-from medical history; (2) BI at testing (an ALSFRS-R-Bulbar score ≤11); (3) dysarthria (a score ≤3 on item 1 of the ALSFRS-R); (4) severity of BI (the total score on the ALSFRS-R-Bulbar); and (5) progression rate of BI (computed as 12-ALSFRS-R-Bulbar/disease duration in months). Logistic regressions were run to predict a below- vs. above-cutoff performance on each ECAS measure based on BI-related features while accounting for sex, disease duration, severity and progression rate of respiratory and spinal involvement and ECAS response modality. Results No predictors yielded significance either on the ECAS-Total and -ALS-non-specific or on ECAS-Language/-Fluency or -Visuospatial subscales. BI at testing predicted a higher probability of an abnormal performance on the ECAS-ALS-specific (p = 0.035) and ECAS-Executive Functioning (p = 0.018). Lower ALSFRS-R-Bulbar scores were associated with a defective performance on the ECAS-Memory (p = 0.025). No other BI-related features affected other ECAS performances. Discussion In ALS, the occurrence of BI itself, while neither its specific features nor its presence at onset, might selectively represent a risk factor for executive impairment, whilst its severity might be associated with memory deficits.
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Affiliation(s)
- Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Silvia Torre
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Valerio Patisso
- Neurology Residency Program, Università Degli Studi di Milano, Milan, Italy
| | - Alberto De Lorenzo
- Neurology Residency Program, Università Degli Studi di Milano, Milan, Italy
| | - Mauro Treddenti
- Neurology Residency Program, Università Degli Studi di Milano, Milan, Italy
| | - Eleonora Colombo
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessio Maranzano
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Claudia Morelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alberto Doretti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università Degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università Degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università Degli Studi di Milano, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
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