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Alkhayat D, Khawaji ZY, Sunyur AM, Sanyour OA, Badawi AS. Overview of Paraneoplastic Autoantibody-Mediated Cognitive Impairment and Behavioral Changes: A Narrative Review. Cureus 2024; 16:e51787. [PMID: 38322089 PMCID: PMC10846349 DOI: 10.7759/cureus.51787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 02/08/2024] Open
Abstract
Cognitive dysfunction and behavioral change can be some of the manifestations of cancer, occurring as a part of paraneoplastic neurological syndrome, most commonly in small cell lung cancer. Paraneoplastic limbic encephalitis is the leading cause of cognitive disturbance and abnormal behavior in paraneoplastic syndromes, which is usually autoantibody-mediated. Autoantibodies are the main contributors to the development of cognitive dysfunction and behavioral change in cancer patients, with studies suggesting a higher liability for antibody-positive cancer patients to be affected. Anti-NMDAR and anti-AMPAR are antibodies targeted against surface antigens, manifesting predominantly as memory disturbance, abnormal behavior, psychiatric symptoms, and seizures. Other surface antigen-targeted antibodies include anti-GABA, anti-CASPR2, and anti-LGI1, which were shown to have cognitive function impairment and abnormal behavior as some of the main presentations, predominantly affecting memory. Cognitive deterioration and changes in behavior were also relatively common with some of the intracellular antigen-targeted antibodies, including anti-Hu, anti-SOX1, anti-PCA2, and anti-Zic2. Affected behavior and cognition, however, were reported less commonly in other paraneoplastic antibodies against intracellular antigens (anti-Yo, anti-GAD, anti-Ma2, anti-Ri, anti-CV2, and anti-KLHL11). Our article will provide a comprehensive review of the clinical manifestations of cognitive impairment and behavioral changes among cancer patients who develop paraneoplastic syndrome. Additionally, this review will discuss the role of specific paraneoplastic autoantibodies and the clinical spectrum linked to each separately.
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Affiliation(s)
| | | | - Amal M Sunyur
- Medicine and Surgery, Taibah University, Medina, SAU
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2
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Liang C, Chu E, Kuoy E, Soun JE. Autoimmune-mediated encephalitis and mimics: A neuroimaging review. J Neuroimaging 2023; 33:19-34. [PMID: 36217010 DOI: 10.1111/jon.13060] [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: 06/15/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 02/01/2023] Open
Abstract
Autoimmune encephalitis is a category of autoantibody-mediated neurological disorders that often presents a diagnostic challenge due to its variable clinical and imaging findings. The purpose of this image-based review is to provide an overview of the major subtypes of autoimmune encephalitis and their associated autoantibodies, discuss their characteristic clinical and imaging features, and highlight several disease processes that may mimic imaging findings of autoimmune encephalitis. A literature search on autoimmune encephalitis was performed and publications from neuroradiology, neurology, and nuclear medicine literature were included. Cases from our institutional database that best exemplify major imaging features were presented.
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Affiliation(s)
- Conan Liang
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, California, USA
| | - Eleanor Chu
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, California, USA
| | - Edward Kuoy
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, California, USA
| | - Jennifer E Soun
- Department of Radiological Sciences, University of California, Irvine Medical Center, Orange, California, USA
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3
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Agarwal A, Mishra B, Gupta A, Srivastava MVP, Basheer A, Sharma J, Vishnu VY. Importance of high-quality evidence regarding the use of Bacopa monnieri in dementia. Front Aging Neurosci 2023; 15:1134775. [PMID: 36936504 PMCID: PMC10014812 DOI: 10.3389/fnagi.2023.1134775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Bacopa monnieri (BM), a commonly used herb, has shown neuroprotective effects in animal and in vitro studies; but human studies on patients with Alzheimer's Disease (AD) have been inconclusive. Further high-quality trials are required to conclusively state the utility of BM in AD and other neurodegenerative dementias. Methods In the present study, we did a narrative review of the current challenges in designing clinical trials of BM in dementia and their evidence-based recommendations. Results Many facets of the BM trials need improvement, especially effect size and sample size estimation. Current assessment and outcomes measures need a more holistic approach and newer scales for diagnosing and monitoring prodromal AD. The stringent guidelines in CONSORT and STROBE are often considered difficult to implement for clinical trials in ayurvedic medications like BM. However, adherence to these guidelines will undoubtedly improve the quality of evidence and go a long way in assessing whether BM is efficacious in treating AD/prodromal AD patients and other neurodegenerative dementias. Conclusion Future studies on BM should implement more randomized controlled trials (RCTs) with an appropriate sample size of accurately diagnosed AD/prodromal AD patients, administering a recommended dosage of BM and for a pre-specified time calculated to achieve adequate power for the study. Researchers should also develop and validate more sensitive cognitive scales, especially for prodromal AD. BM should be evaluated in accordance with the same rigorous standards as conventional drugs to generate the best quality evidence.
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Affiliation(s)
- Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Aneesh Basheer
- DM Wayanad Institute of Medical Sciences (DM WIMS), Wayanad, India
| | - Jyoti Sharma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y. Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
- *Correspondence: Venugopalan Y. Vishnu,
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Magdy R, Hussein M. Cognitive, Psychiatric, and Motor Symptoms-Based Algorithmic Approach to Differentiate Among Various Types of Dementia Syndromes. J Nerv Ment Dis 2022; 210:129-135. [PMID: 35080518 DOI: 10.1097/nmd.0000000000001428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT It may be difficult to distinguish among the various dementia syndromes due to the overlap in many common clinical features across the dementias. Accurate diagnosis of dementia type is increasingly important in an era when promising disease-modifying agents can be marketed soon. In this review, we outline a clinical algorithmic approach particularly tailored to the major forms of dementia in the clinic and refined from our accumulated experience of these patients. We first present an algorithmic approach for patients presenting with predominant deficits in episodic memory, executive function, language, visuospatial, and apraxia. We then consider types of dementia that mainly cause behavioral and psychiatric changes. Finally, we illustrate clinical pearls regarding motor deficits as key associations of each syndrome.
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Affiliation(s)
- Rehab Magdy
- Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo
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Successful Treatment of Incomplete Susac Syndrome with Simultaneous Corticosteroids and Plasmapheresis Followed by Rituximab. Case Rep Neurol Med 2021; 2021:5591559. [PMID: 34567813 PMCID: PMC8457979 DOI: 10.1155/2021/5591559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022] Open
Abstract
We present a case report of a patient with incomplete Susac syndrome. He had cognitive impairment, corpus callosum lesions, and vestibulocochlear dysfunction on brainstem auditory evoked responses. He was treated with methylprednisolone and plasmapheresis, improved, and then, also received rituximab. His improvement has been lasting as of this writing. This case shares our experience with a successful treatment of this rare condition that is incompletely understood and lacks well-established treatment guidelines.
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Tsutsumimoto K, Doi T, Nakakubo S, Kim M, Kurita S, Ishii H, Shimada H, Kawachi I. Impact of Social Frailty on Alzheimer's Disease Onset: A 53-Month Longitudinal Cohort Study. J Alzheimers Dis 2020; 70:587-595. [PMID: 31256123 DOI: 10.3233/jad-181178] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We investigated the association between social frailty and Alzheimer's disease (AD) incidence among community-dwelling older adults in Japan. A 53-month follow-up cohort study was conducted in Obu City, Japan. Participants comprised 3,720 community-dwelling older adults (mean age, 71.7 years; 48.4% men). The operational definition of social frailty comprised five items: going out infrequently, rarely visiting friends, feeling unhelpful to friends or family, living alone, and not always talking with someone each day. During follow-up, the cumulative AD incidence risk between socially robust, pre-frail, and frail groups was 4.1%, 5.5%, and 10.7%, respectively. In both crude (HR 2.72, 95% CI 1.90-3.89, p < 0.001) and adjusted Cox proportional hazards models (HR 1.53, 95% CI 1.03-2.28, p = 0.035), social frailty was associated with a significantly higher AD incidence risk. The present study revealed that social frailty is strongly associated with AD incidence among Japanese older adults. Further research should elucidate whether social frailty prevention is effective for decreasing AD risk.
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Affiliation(s)
- Kota Tsutsumimoto
- Department of Preventive Gerontology, Section for Health Promotion, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Takehiko Doi
- Department of Preventive Gerontology, Section for Health Promotion, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Sho Nakakubo
- Department of Preventive Gerontology, Section for Health Promotion, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Minji Kim
- Department of Preventive Gerontology, Section for Health Promotion, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Satoshi Kurita
- Department of Preventive Gerontology, Section for Health Promotion, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hideaki Ishii
- Department of Preventive Gerontology, Section for Health Promotion, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Rapidly Progressive Dementia: Prevalence and Causes in a Neurologic Unit of a Tertiary Hospital in Brazil. Alzheimer Dis Assoc Disord 2018; 31:239-243. [PMID: 27849640 DOI: 10.1097/wad.0000000000000170] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rapidly progressive dementia (RPD) is usually associated with Creutzfeldt-Jakob disease, a fatal condition. Current advances in the understanding of immune-mediated diseases allow the diagnosis of previously unrecognized treatable RPDs. OBJECTIVE OF THE STUDY The objective of the study was to describe the prevalence and causes of RPD in a neurology service, identifying potentially reversible causes. METHODS We carried out a cross-sectional evaluation of all patients admitted to the neurology unit of a tertiary hospital in Brazil between March 2012 and February 2015. We included patients who had progressed to moderate or severe dementia within a few months or up to 2 years at the time of hospitalization, and used multivariable logistic regression analysis to identify factors associated with a favorable outcome. RESULTS We identified 61 RPD (3.7%) cases among 1648 inpatients. Mean RPD patients' age was 48 years, and median time to progression was 6.4 months. Immune-mediated diseases represented the most commonly observed disease group in this series (45.9% of cases). Creutzfeldt-Jakob disease (11.5%) and nonprion neurodegenerative diseases (8.2%) were less common in this series. Outcome was favorable in 36/61 (59.0%) RPD cases and in 28/31 (89.3%) of immune-mediated cases. Favorable outcome was associated with shorter time from symptom onset to diagnosis and abnormal cerebrospinal fluid findings. CONCLUSIONS Immune-mediated diseases were the most common cause of RPD in this series. Timely evaluation and diagnosis along with institution of appropriate therapy are required in RPD, especially in view of potentially reversible causes.
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Social Engagement and Its Change are Associated with Dementia Risk among Chinese Older Adults: A Longitudinal Study. Sci Rep 2018; 8:1551. [PMID: 29367696 PMCID: PMC5784173 DOI: 10.1038/s41598-017-17879-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 11/27/2017] [Indexed: 11/12/2022] Open
Abstract
This study aimed to examine the association of social engagement (SE) and changes in SE with the risk of dementia among older adults in China. Data were collected from the 2002, 2005, 2008/2009, and 2011/2012 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Random-effects logistic regression models were used to examine the association of SE and changes in SE with the risk of dementia. Of the 7511 older Chinese adults aged 65 years and over, 338 developed dementia during the 9-year follow-up. SE was associated with dementia risk after adjusting for sociodemographic characteristics, lifestyles and health status (odds ratio (OR) = 0.71, 95% confidence interval (CI) = 0.63–0.81). Participants with consistently high or increased SE had a lower risk of dementia than those with consistently low SE ((OR = 0.14, 95% CI = 0.06–0.28 and OR = 0.33, 95% CI = 0.23–0.48, respectively). Higher SE can reduce the risk of dementia. Furthermore, consistently high or increasing SE is associated with a lower risk of dementia.
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Kelley BP, Patel SC, Marin HL, Corrigan JJ, Mitsias PD, Griffith B. Autoimmune Encephalitis: Pathophysiology and Imaging Review of an Overlooked Diagnosis. AJNR Am J Neuroradiol 2017; 38:1070-1078. [PMID: 28183838 DOI: 10.3174/ajnr.a5086] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Autoimmune encephalitis is a relatively new category of immune-mediated disease involving the central nervous system that demonstrates a widely variable spectrum of clinical presentations, ranging from the relatively mild or insidious onset of cognitive impairment to more complex forms of encephalopathy with refractory seizure. Due to its diverse clinical features, which can mimic a variety of other pathologic processes, autoimmune encephalitis presents a diagnostic challenge to clinicians. Imaging findings in patients with these disorders can also be quite variable, but recognizing characteristic findings within limbic structures suggestive of autoimmune encephalitis can be a key step in alerting clinicians to the potential diagnosis and ensuring a prompt and appropriate clinical work-up. In this article, we review antibody-mediated encephalitis and its various subtypes with a specific emphasis on the role of neuroimaging in the diagnostic work-up.
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Affiliation(s)
- B P Kelley
- From the Departments of Neuroradiology (B.P.K., S.C.P., H.L.M., J.J.C., B.G.)
| | - S C Patel
- From the Departments of Neuroradiology (B.P.K., S.C.P., H.L.M., J.J.C., B.G.)
| | - H L Marin
- From the Departments of Neuroradiology (B.P.K., S.C.P., H.L.M., J.J.C., B.G.)
| | - J J Corrigan
- From the Departments of Neuroradiology (B.P.K., S.C.P., H.L.M., J.J.C., B.G.)
| | - P D Mitsias
- Neurology (P.D.M.), Henry Ford Hospital, Detroit, Michigan
| | - B Griffith
- From the Departments of Neuroradiology (B.P.K., S.C.P., H.L.M., J.J.C., B.G.)
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10
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Bertrand JMF, Martinon LM, Souchay C, Moulin CJA. History repeating itself: Arnaud's case of pathological déjà vu. Cortex 2016; 87:129-141. [PMID: 27188828 DOI: 10.1016/j.cortex.2016.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 02/13/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
We present a translation of Arnaud's (1896) case report of Patient Louis, a case he describes as having a pathological form of déjà vu. Louis has the delusional belief that the present moment is a repetition of an exact same previous event. Arnaud's paper is critical for two reasons. Firstly, it is amongst the first articles in the scientific literature to describe the déjà vu experience using the term 'déjà vu'. Secondly, the case report of someone with delusional and persistent déjà vu, anticipates recently reported cases with similar symptoms, which are beginning to gain interest as a particular form of memory disorder. We offer a contemporary analysis of Louis and conclude that, whilst the article was critical in the development of déjà vu as a scientific concern, Louis's distorted memory is not best described as déjà vu, but rather as a form of reduplicative paramnesia described as recollective confabulation.
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Affiliation(s)
- Julie M F Bertrand
- Centre d'épidémiologie de populations et de santé publique de Bourgogne, EA 4184, Université de Bourgogne, France
| | | | - Céline Souchay
- Laboratoire de Psychologie et Neurocognition, LPNC CNRS 5105, Université Grenoble Alpes, France
| | - Chris J A Moulin
- Laboratoire de Psychologie et Neurocognition, LPNC CNRS 5105, Université Grenoble Alpes, France.
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Monitoring the Effect of Immunotherapy in Autoimmune Limbic Encephalitis Using 18F-FDG PET. Clin Nucl Med 2015; 40:e441-3. [DOI: 10.1097/rlu.0000000000000839] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Kansal K, Irwin DJ. The use of cerebrospinal fluid and neuropathologic studies in neuropsychiatry practice and research. Psychiatr Clin North Am 2015; 38:309-22. [PMID: 25998118 PMCID: PMC4443852 DOI: 10.1016/j.psc.2015.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The gold standard for diagnosis of neurodegenerative diseases (ie, Alzheimer disease, frontotemporal dementia, Parkinson disease, dementia with Lewy bodies, amyotrophic lateral sclerosis) is neuropathologic examination at autopsy. As such, laboratory studies play a central role in antemortem diagnosis of these conditions and their differentiation from the neuroinflammatory, infectious, toxic, and other nondegenerative etiologies (eg, rapidly progressive dementias) that are encountered in neuropsychiatric practice. This article summarizes the use of cerebrospinal fluid (CSF) laboratory studies in the diagnostic evaluation of dementia syndromes and emerging CSF biomarkers specific for underlying neuropathology in neurodegenerative disease research.
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Affiliation(s)
- Kalyani Kansal
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - David J. Irwin
- Department of Neurology, University of Pennsylvania Perelman School of medicine, Philadelphia, PA USA
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Irani SR, Gelfand JM, Al-Diwani A, Vincent A. Cell-surface central nervous system autoantibodies: clinical relevance and emerging paradigms. Ann Neurol 2014; 76:168-84. [PMID: 24930434 PMCID: PMC4141019 DOI: 10.1002/ana.24200] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 06/13/2014] [Accepted: 06/13/2014] [Indexed: 01/17/2023]
Abstract
The recent discovery of several potentially pathogenic autoantibodies has helped identify patients with clinically distinctive central nervous system diseases that appear to benefit from immunotherapy. The associated autoantibodies are directed against the extracellular domains of cell-surface-expressed neuronal or glial proteins such as LGI1, N-methyl-D-aspartate receptor, and aquaporin-4. The original descriptions of the associated clinical syndromes were phenotypically well circumscribed. However, as availability of antibody testing has increased, the range of associated patient phenotypes and demographics has expanded. This in turn has led to the recognition of more immunotherapy-responsive syndromes in patients presenting with cognitive and behavioral problems, seizures, movement disorders, psychiatric features, and demyelinating disease. Although antibody detection remains diagnostically important, clinical recognition of these distinctive syndromes should ensure early and appropriate immunotherapy administration. We review the emerging paradigm of cell-surface-directed antibody-mediated neurological diseases, describe how the associated disease spectrums have broadened since the original descriptions, discuss some of the methodological issues regarding techniques for antibody detection and emphasize considerations surrounding immunotherapy administration. As these disorders continue to reach mainstream neurology and even psychiatry, more cell-surface-directed antibodies will be discovered, and their possible relevance to other more common disease presentations should become more clearly defined.
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Affiliation(s)
- Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Multiple Sclerosis and Neuroinflammation Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
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Bechtel K, Geschwind MD. Ethics in prion disease. Prog Neurobiol 2013; 110:29-44. [PMID: 23906487 PMCID: PMC3818451 DOI: 10.1016/j.pneurobio.2013.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 07/05/2013] [Accepted: 07/06/2013] [Indexed: 12/13/2022]
Abstract
This paper is intended to discuss some of the scientific and ethical issues that are created by increased research efforts towards earlier diagnosis, as well as to treatment of, human prion diseases (and related dementias), including the resulting consequences for individuals, their families, and society. Most patients with prion disease currently are diagnosed when they are about 2/3 of the way through their disease course (Geschwind et al., 2010a; Paterson et al., 2012b), when the disease has progressed so far that even treatments that stop the disease process would probably have little benefit. Although there are currently no treatments available for prion diseases, we and others have realized that we must diagnose patients earlier and with greater accuracy so that future treatments have hope of success. As approximately 15% of prion diseases have a autosomal dominant genetic etiology, this further adds to the complexity of ethical issues, particularly regarding when to conduct genetic testing, release of genetic results, and when or if to implement experimental therapies. Human prion diseases are both infectious and transmissible; great care is required to balance the needs of the family and individual with both public health needs and strained hospital budgets. It is essential to proactively examine and address the ethical issues involved, as well as to define and in turn provide best standards of care.
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Affiliation(s)
- Kendra Bechtel
- Memory and Aging Center, University of California, San Francisco, United States
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Fortes GCC, Oliveira MCB, Lopes LCG, Tomikawa CS, Lucato LT, Castro LHM, Nitrini R. Rapidly progressive dementia due to neurosarcoidosis. Dement Neuropsychol 2013; 7:428-434. [PMID: 29213869 PMCID: PMC5619506 DOI: 10.1590/s1980-57642013dn74000012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Rapidly progressive dementia (RPD) is typically defined as a cognitive decline
progressing to severe impairment in less than 1-2 years, typically within weeks
or months. Accurate and prompt diagnosis is important because many conditions
causing RPD are treatable. Neurosarcoidosis is often cited as an unusual
reversible cause of RPD.
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Affiliation(s)
| | | | - Laura Cardia G Lopes
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
| | - Camila S Tomikawa
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
| | - Leandro T Lucato
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
| | - Luiz Henrique M Castro
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
| | - Ricardo Nitrini
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
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Bucelli RC, Ances BM. Diagnosis and evaluation of a patient with rapidly progressive dementia. MISSOURI MEDICINE 2013; 110:422-8. [PMID: 24279195 PMCID: PMC4217278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
While the most common dementia is Alzheimer disease (AD), a detailed history is needed to rule out rapidly progressive dementias (RPDs). RPDs are less than two years in duration and have a rate of progression faster typical neurodegenerative diseases. Identification of RPDs is important as some are treatable. This review focuses on the spectrum of RPDs, with special emphasis on paraneoplastic disorders and Creutzfeldt-Jakob disease (CJD).
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Affiliation(s)
- Robert C Bucelli
- Department of Neurology, Washington University School of Medicine, St. Louis, USA
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17
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Paterson RW, Takada LT, Geschwind MD. Diagnosis and treatment of rapidly progressive dementias. Neurol Clin Pract 2012; 2:187-200. [PMID: 23634367 DOI: 10.1212/cpj.0b013e31826b2ae8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Rapidly progressive dementias are conditions that typically cause dementia over weeks or months. They are a particular challenge to neurologists as the differential diagnosis often is different from the more typical, slowly progressive dementias. Early and accurate diagnosis is essential, as many of the etiologies are treatable. The information in this review is in part based on experience through our rapidly progressive dementia program at the University of California San Francisco, Memory and Aging Center. As treatment of a rapidly progressive dementia is entirely dependent on the diagnosis, we present a comprehensive, structured, but pragmatic approach to diagnosis, including key clinical, laboratory, and radiologic features. For the 2 most common causes of rapid dementia, treatment algorithms for the autoimmune encephalopathies and symptomatic management for the neurodegenerative causes are discussed.
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Affiliation(s)
- Ross W Paterson
- University of California (RWP, LTT, MDG), San Francisco Memory and Aging Center, San Francisco; National Hospital for Neurology and Neurosurgery (RWP), Queen Square, London, UK; and Department of Neurology (LTT), University of Sao Paulo, Sao Paulo, Brazil
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