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Ghadirzade Arani L, Advani S, Mardani G, Moslemi Haghighi S, Abdollahimajd F, Robati RM, Mozafari N, Moravvej H, Gheisari M, Nasiri S, Dadkhahfar S. Mild cognitive impairment in pemphigus. Int J Dermatol 2024. [PMID: 38702904 DOI: 10.1111/ijd.17229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/26/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Pemphigus is a group of autoimmune blistering disorders that have been associated with dementia in previous studies. Mild cognitive impairment (MCI) can be the first stage of progression into dementia. The objective of the present study was to evaluate the frequency of MCI in pemphigus patients compared to a control group. METHODS This case-control study included 80 patients with pemphigus referred to the dermatology clinics of Shohadaye Tajrish and Loghman Hakim hospitals, Tehran, Iran, in 2021. A group of 80 individuals without pemphigus who visited the same clinics for cosmetic consultation or interventions were regarded as controls. Age, sex, marital status, and education were recorded for all participants. Disease duration, medications, and severity were noted for pemphigus patients. The Persian version of the Montreal Cognitive Assessment (MoCA) test was used to assess cognitive function. RESULTS MCI was significantly more frequent in pemphigus patients than in controls (55% vs. 37.5%, P = 0.026). Furthermore, the total MoCA score was significantly lower in pemphigus patients compared to controls (23.98 ± 3.77 vs. 25.21 ± 3.45, P = 0.032); however, among MoCA's different domains, only the executive functions score was significantly lower in pemphigus patients (P = 0.010). After adjustment, multivariable logistic regression analysis revealed that every 1-year higher education in patients decreased the odds of MCI by 52% (adjusted odds ratio = 0.483, 95% confidence interval 0.326; 0.715, P < 0.001). CONCLUSIONS The frequency of MCI was found to be significantly higher, and overall scores of the MoCA test, as well as its executive function domain, were significantly lower among pemphigus patients in this study compared to the control group. Additionally, a higher level of education was associated with decreased odds of MCI in pemphigus patients. Identifying pemphigus patients with MCI through the use of the MoCA test can facilitate early intervention, enabling them to seek help and support.
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Affiliation(s)
| | - Soroor Advani
- Neurology Department, Shohada Tajrish Hospital, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazal Mardani
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nikoo Mozafari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Moravvej
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Gheisari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Nasiri
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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2
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Yi X, Wang X, Fu Y, Luo Y, Wang J, Han Z, Kuang Y, Chen X, Chen BT. Altered brain activity and cognitive impairment in patients with psoriasis. J Eur Acad Dermatol Venereol 2024; 38:557-567. [PMID: 38059666 DOI: 10.1111/jdv.19685] [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: 05/14/2023] [Accepted: 10/25/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Patients with psoriasis may have cognitive impairment. However, there is limited information regarding intrinsic brain activity and cognitive function in patients with psoriasis. OBJECTIVES This study aim to assess alterations of intrinsic brain activity and its association with cognitive function in patients with psoriasis. METHODS A total of 222 patients with psoriasis aged 18-70 years and 144 age and gender-matched healthy controls (HCs) were enrolled into this study. All subjects underwent brain resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychological testing. The rs-fMRI data were analysed for both intrinsic brain activity as indicated by amplitude of low-frequency fluctuation (ALFF) and seed-based functional connectivity (FC). Correlative analysis of brain activity with cognitive assessment was performed. RESULTS Compared with the HCs, patients with psoriasis had worse cognitive performance in the Trail Making Test, Digit Span Test and Stroop Color-Word Test (p < 0.05). Patients with psoriasis showed decreased ALFF in the left superior frontal gyrus, the left medial superior frontal gyrus and the right precuneus gyrus; as well as enhanced ALFF in the left paracentral lobule (pFWE < 0.05). Significant correlations were noted between the altered ALFF in the four brain regions and cognitive assessment (p < 0.05). Moreover, patients with psoriasis had increased FC between the four brain regions with altered ALFF (seeds) and the left prefrontal gyrus, the left anterior cingulate gyrus, left superior parietal lobule and default mode network (DMN) regions such as the right precuneus gyrus, left inferior parietal lobule, right angular gyrus and bilateral inferior temporal gyrus (pFWE < 0.05). CONCLUSIONS Patients with psoriasis had altered brain activity and connectivity in the key brain areas within the DMN-prefrontal circuit. These brain changes may be the underlying neural correlates for cognitive functioning in patients with psoriasis.
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Affiliation(s)
- Xiaoping Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xueying Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha, Hunan, China
| | - Yan Fu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha, Hunan, China
| | - Yan Luo
- Department of Dermatology, People's Hospital of Jiangxi Province, Nanchang, Jiangxi, China
| | - Jing Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zaide Han
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yehong Kuang
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiang Chen
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, California, USA
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3
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Gwinnutt JM, Toyoda T, Barraclough M, Verstappen SMM, Hornberger M, MacGregor A. Cognitive impairment in the immune-mediated inflammatory diseases compared with age-matched controls: Systematic review and meta-regression. Semin Arthritis Rheum 2023; 58:152131. [PMID: 36527929 DOI: 10.1016/j.semarthrit.2022.152131] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/31/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare the magnitude of cognitive impairment against age-expected levels across the immune mediated inflammatory diseases (IMIDs: systemic lupus erythematosus [SLE], rheumatoid arthritis [RA], axial spondyloarthritis [axSpA], psoriatic arthritis [PsA], psoriasis [PsO]). METHODS A pre-defined search strategy was implemented in Medline, Embase and Psychinfo on 29/05/2021. Inclusion criteria were: (i) observational studies of an IMID, (ii) healthy control comparison, (iii) measuring cognitive ability (overall, memory, complex attention/executive function, language/verbal fluency), and (iv) sufficient data for meta-analysis. Standardised mean differences (SMD) in cognitive assessments between IMIDs and controls were pooled using random-effects meta-analysis. IMIDs were compared using meta-regression. RESULTS In total, 65 IMID groups were included (SLE: 39, RA: 19, axSpA: 1, PsA: 2 PsO: 4), comprising 3141 people with IMIDs and 9333 controls. People with IMIDs had impairments in overall cognition (SMD: -0.57 [95% CI -0.70, -0.43]), complex attention/executive function (SMD -0.57 [95% CI -0.69, -0.44]), memory (SMD -0.55 [95% CI -0.68, -0.43]) and language/verbal fluency (SMD -0.51 [95% CI -0.68, -0.34]). People with RA and people with SLE had similar magnitudes of cognitive impairment in relation to age-expected levels. People with neuropsychiatric SLE had larger impairment in overall cognition compared with RA. CONCLUSIONS People with IMIDs have moderate impairments across a range of cognitive domains. People with RA and SLE have similar magnitudes of impairment against their respective age-expected levels, calling for greater recognition of cognitive impairment in both conditions. To further understand cognition in the IMIDs, more large-scale, longitudinal studies are needed.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Task Toyoda
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Michelle Barraclough
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK; Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | | | - Alex MacGregor
- Norwich Medical School, University of East Anglia, Norwich, UK; Rheumatology Department, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
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4
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Wen S, Elias PM, Wakefield JS, Mauro TM, Man MQ. The link between cutaneous inflammation and cognitive impairment. J Eur Acad Dermatol Venereol 2022; 36:1705-1712. [PMID: 35748522 PMCID: PMC9481668 DOI: 10.1111/jdv.18360] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/30/2022] [Indexed: 12/01/2022]
Abstract
Cognitive impairment is a symptom of neurological disorders, including dementia and Alzheimer's disease; and mild cognitive impairment can be a precursor of both disorders. Aged humans and animal models with other systemic disorders, such as cardiovascular diseases and diabetes, display a higher incidence of cognitive decline. Epidemiological studies have shown that the incidence of cognitive impairment also is higher in subjects with certain inflammatory skin disorders, including psoriasis and chronic eczematous dermatitis. Chronologically aged individuals exhibit increased cutaneous inflammation and elevated circulating cytokine levels, linked to alterations in epidermal function, which itself can induce cutaneous inflammation. Conversely, strategies that improve epidermal function can lower cytokine levels in both the skin and circulation. Thus, it seems likely that epidermal dysfunction could contribute, at least in part, to the development of chronic low-grade inflammation, also termed 'inflammaging', in the elderly. The evidence of cognitive impairment in patients with inflammatory dermatoses suggests a link between cutaneous inflammation and cognitive impairment. Because of the pathogenic role of epidermal dysfunction in ageing-associated cutaneous inflammation, improvements in epidermal function could be an alternative approach for mitigation of the ageing-associated decline in cognitive function.
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Affiliation(s)
- S Wen
- Dermatology Hospital, Southern Medical University, Guangdong, China
| | - P M Elias
- Dermatology Service, Veterans Affairs Medical Center San Francisco, San Francisco, California, USA
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - J S Wakefield
- Dermatology Service, Veterans Affairs Medical Center San Francisco, San Francisco, California, USA
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - T M Mauro
- Dermatology Service, Veterans Affairs Medical Center San Francisco, San Francisco, California, USA
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - M-Q Man
- Dermatology Hospital, Southern Medical University, Guangdong, China
- Dermatology Service, Veterans Affairs Medical Center San Francisco, San Francisco, California, USA
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
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5
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Baran A, Nowowiejska J, Hermanowicz JM, Sieklucka B, Krahel JA, Kiluk P, Pawlak D, Flisiak I. The Potential Role of Serum Tau Protein (MAPT), Neuronal Cell Adhesion Molecule (NrCAM) and Neprilysin (NEP) in Neurodegenerative Disorders Development in Psoriasis-Preliminary Results. J Clin Med 2022; 11:jcm11175044. [PMID: 36078974 PMCID: PMC9456661 DOI: 10.3390/jcm11175044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/20/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Psoriasis is one of the most common dermatoses, which shortens patients’ lives because of the wide comorbidity. However, little is known about its association with neurodegenerative diseases (NDs). We aimed to investigate whether psoriatics are at increased risk of NDs. Sixty patients with plaque-type psoriasis were enrolled into the study. Serum concentrations of tau protein (MAPT), neuronal cell adhesion molecule (NrCAM) and neprilysin (NEP), which are NDs biomarkers and have been hardly studied in psoriasis before, were measured before and after 12 weeks of treatment with acitretin or methotrexate. NrCAM and NEP concentrations were significantly lower in patients than controls, whereas MAPT higher (all p < 0.05). There was no association between these markers and psoriasis severity, BMI or disease duration. After the treatment the concentration of NrCAM and NEP significantly increased and MAPT decreased (p < 0.001, p < 0.05, p < 0.01, respectively). Methotrexate had significant influence on the concentrations of all markers, hence it seems to have neuroprotective properties. Psoriasis severity and duration do not seem to affect the risk of neurodegenerative process. Our results suggest that NDs could be considered as another comorbidity of psoriasis and that further research are needed in order to establish their definite association.
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Affiliation(s)
- Anna Baran
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St., 15-540 Bialystok, Poland
- Correspondence:
| | - Julia Nowowiejska
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St., 15-540 Bialystok, Poland
| | | | - Beata Sieklucka
- Department of Pharmacodynamics, Medical University of Bialystok, Mickiewicza 2C St., 15-540 Bialystok, Poland
| | - Julita Anna Krahel
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St., 15-540 Bialystok, Poland
| | - Paulina Kiluk
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St., 15-540 Bialystok, Poland
| | - Dariusz Pawlak
- Department of Pharmacodynamics, Medical University of Bialystok, Mickiewicza 2C St., 15-540 Bialystok, Poland
| | - Iwona Flisiak
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St., 15-540 Bialystok, Poland
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6
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Pankowski D, Wytrychiewicz-Pankowska K, Owczarek W. Cognitive impairment in psoriasis patients: a systematic review of case-control studies. J Neurol 2022; 269:6269-6278. [PMID: 35945395 PMCID: PMC9618480 DOI: 10.1007/s00415-022-11317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/22/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022]
Abstract
Introduction Cognitive impairment in chronic diseases such as psoriasis is an increasing clinical challenge. Objective To assess the frequency and extent of difficulties in cognitive functioning in people with psoriasis compared to healthy people. Patients and methods The systematic review was carried out on the 23rd July, 2021 by two trained psychologists resulting in a selection of 11 studies on 971 patients with psoriasis and 10,242 controls. Results A review of the studies showed irregularities in many cognitive domains, including working memory processes, executive functions, long-term verbal memory, attention, and the visuospatial domain. Depending on the methods used to assess cognitive dysfunctions and the characteristics of patients in different studies, large differences in the frequency of cognitive impairment in patients with psoriasis were observed, ranging from 0 to 91.9%. Conclusions The authors conclude that there is a need for longitudinal studies to identify factors important for the development and persistence of cognitive impairment in psoriatic patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11317-2.
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Affiliation(s)
- Daniel Pankowski
- University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland. .,University of Economics and Human Sciences in Warsaw, Warsaw, Poland.
| | - K Wytrychiewicz-Pankowska
- University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland.,University of Economics and Human Sciences in Warsaw, Warsaw, Poland
| | - W Owczarek
- Department of Dermatology, Military Institute of Medicine, Warsaw, Poland
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7
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Cognition/Psychological Burden and Resilience in Cutaneous T-Cell Lymphoma and Psoriasis Patients: Real-Life Data and Implications for the Treatment. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8802469. [PMID: 35937394 PMCID: PMC9348939 DOI: 10.1155/2022/8802469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/14/2022] [Accepted: 06/28/2022] [Indexed: 01/09/2023]
Abstract
Background. Psoriasis and cutaneous T-cell lymphoma (CTCL) expose patients to chronic inflammation as well as physical and psychological disabilities, but the impact of such alterations on cognitive function is unknown. Objective. This study is aimed at determining if CTCL and psoriasis impact cognitive functioning in relation to psychological and health-related quality of life (HR-QOL) status. Methods. A cross-sectional study was performed in an outpatient dermatology clinic of a university teaching hospital. Thirty-nine subjects with CTCL (
) or psoriasis (
) who met eligibility criteria were included. The cognitive domains of memory, attention and processing speed, and executive function were assessed with standard neuropsychological tests. Subjects were assessed for depression, anxiety, and HR-QOL (using the SKINDEX-29 questionnaire). Results. Study participants were CTCL and psoriasis subjects; cognitive impairment was found in the domain of memory in 17.9% subjects with CTCL or psoriasis. Lower scores on executive function tests were predicted by higher (worse HR-QOL) SKINDEX-29 functioning scores (
). A higher estimated baseline intellectual functioning predicted lower scores (better HR-QOL) on the symptoms and functioning domains of SKINDEX-29 (
and 0.02, respectively) and a statistical trend (
) for the emotion domain. Memory and acute anxiety were adversely impacted by shorter disease duration (
for both). Conclusions. Memory impairment may be associated comorbidity in CTCL and psoriasis. Subjects with stronger cognitive resources appear to cope better with health-related quality of life (HR-QOL) challenges.
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8
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Cognitive Functions Associated with Brain Imaging Markers in Patients with Psoriasis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095687. [PMID: 35565082 PMCID: PMC9105445 DOI: 10.3390/ijerph19095687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023]
Abstract
Psoriasis is a severe inflammatory disease associated with a higher comorbidity of depression, cognitive dysfunction and brain atrophy. The association between psoriasis, magnetic resonance imaging (MRI) markers and cognitive impairment has rarely been investigated, and the existing results are conflicting. Methods. This study included 89 subjects (53 patients with psoriasis and 36 healthy controls). The severity of psoriasis was evaluated using the Psoriasis Area and Severity Index (PASI) score; for depression, the Hospital Anxiety and Depression Scale (HADS) scale was used. Neuropsychological tests were also applied, including a Trail Making Test (TMT) as well as Digit Span, Stroop, Verbal Fluency and Rey Auditory Verbal Learning tests. MRI scans were performed using a 1.5 T scanner. Brain volumetry, white matter lesions, grey matter and white matter were evaluated. The extent of these changes was assessed on the Fazekas scale. The differences between groups were evaluated using a Student’s t-test and a Mann-Whitney U test, and a Pearson correlation analysis was also performed. Results. Patients with psoriasis presented worse achievements on all the neuropsychological tests and showed more intense changes on MRI compared to healthy controls. The severity of psoriasis as determined by PASI scores was associated with depression, and a greater psychomotor slowness severity of changes in the brain was associated with poorer results on the neurological tests. Conclusions. Our results indicate the possibility of progressive brain atrophy related to cognitive decline in psoriasis.
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9
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Zhang H, Zhang D, Tang K, Sun Q. The Relationship Between Alzheimer's Disease and Skin Diseases: A Review. Clin Cosmet Investig Dermatol 2021; 14:1551-1560. [PMID: 34729018 PMCID: PMC8554316 DOI: 10.2147/ccid.s322530] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/15/2021] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease is the most common type of dementia placing a heavy burden on the healthcare system worldwide. Skin diseases are also one of the most common health problems. Several skin diseases are associated with Alzheimer's disease through different mechanisms. This review summarizes the relationship between Alzheimer's disease and several types of skin diseases, including bullous pemphigoid, hidradenitis suppurativa, psoriasis, skin cancer, and cutaneous amyloidosis, and provides suggestions based on these associations. Neurologists, dermatologists, and general practitioners should be aware of the relationship between Alzheimer's disease and skin diseases. Dermatology/neurology consultation or referral is necessary when needed.
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Affiliation(s)
- Hanlin Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Dingyue Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Keyun Tang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Qiuning Sun
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
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10
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Kuang Y, Luo Y, Yi X, Wang Q, Wang C, Shen M, Fu Y, Shu G, Li R, Zhu L, Pang P, Zhang Y, Zhu W, Chen X, Chen BT. Prevalence and risk factors for cognitive impairment in patients with psoriasis. J Eur Acad Dermatol Venereol 2021; 36:e152-e155. [PMID: 34582578 DOI: 10.1111/jdv.17707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/17/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Y Kuang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Y Luo
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - X Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Q Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - C Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - M Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Y Fu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - G Shu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - R Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - L Zhu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - P Pang
- GE Healthcare, Hangzhou, China
| | - Y Zhang
- Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - W Zhu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - X Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - B T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, USA
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11
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Di Carlo M, Becciolini A, Incorvaia A, Beci G, Smerilli G, Biggioggero M, Tardella M, De Angelis R, Salaffi F. Mild cognitive impairment in psoriatic arthritis: Prevalence and associated factors. Medicine (Baltimore) 2021; 100:e24833. [PMID: 33725953 PMCID: PMC7982208 DOI: 10.1097/md.0000000000024833] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023] Open
Abstract
To assess the prevalence and factors associated with mild cognitive impairment (MCI) in patients suffering from psoriatic arthritis (PsA).A cross-sectional evaluation was conducted in consecutive PsA patients. Sociodemographic data and the clinimetric variables related to PsA and psoriasis were collected for each patient. MCI was assessed through the Montreal Cognitive Assessment (MoCA). The cognitive performance of PsA patients was compared to healthy subjects using one-way analysis of variance (ANOVA). The correlations among variables were studied by the Spearman rank correlation coefficient. A multivariate logistic regression analysis was carried out to establish the predictors of MCI.The study involved 96 PsA patients and 48 healthy subjects. MCI (defined as a MoCA score < 26/30) was detected in 47 (48.9%) PsA patients. Compared to healthy subjects, the MoCA score resulted significantly lower in PsA patients (P = .015). The main differences involved the denomination and language domains. MoCA was negatively correlated with age (r = -0.354; P < .0001), HAQ-DI (r = -0.227; P = .026), and fatigue (r = -0.222; P = .029), and positively correlated with psoriasis duration (r = 0.316; P = .001) and DLQI (r = 0.226; P = .008).The multivariate logistic regression analysis revealed the duration of psoriasis (P = .0005), age (P = .0038), PASI (P = .0050), and HAQ-DI (P = .0193) as predictors of the MoCA score.MCI is present in a significant proportion of PsA patients, and is mainly determined by age, cutaneous variables, and disability.
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Affiliation(s)
- Marco Di Carlo
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
| | - Andrea Becciolini
- Department of Rheumatology, “Gaetano Pini”-CTO Institute, Milan, Italy
| | - Antonella Incorvaia
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
| | - Giacomo Beci
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
| | - Gianluca Smerilli
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
| | | | - Marika Tardella
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
| | - Rossella De Angelis
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
| | - Fausto Salaffi
- Rheumatology Clinic, Università Politecnica delle Marche, “Carlo Urbani” Hospital, Jesi (Ancona)
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12
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Liu L, Chen ST, Li HJ, Qiang Y, Sun XY, Zhou YQ, Xing M, Luo Y, Ru Y, Ding XJ, Kuai L, Li B, Li X. Association Between Psoriasis and Dementia: Current Evidence. Front Aging Neurosci 2020; 12:570992. [PMID: 33192461 PMCID: PMC7642958 DOI: 10.3389/fnagi.2020.570992] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/12/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Psoriasis and dementia are both inflammatory diseases. The association between psoriasis and dementia has rarely been investigated, and the existing results are conflicting. Thus, we conducted this study to evaluate whether an association exists between psoriasis and dementia. Methods: We searched for studies from six databases from inception to July 30, 2020, using subject and free words. RevMan 5.4 was used to calculate the risk ratio (RR) of dementia in the subjects with psoriasis. When heterogeneity was present, a random-effects model was used. Subgroup, sensitivity, and meta-regression analyses were performed using Stata 15.1. Results: Nine studies were identified and included in the study, of which seven that involved a total of 3,638,487 participants were included in the meta-analysis. We found that among the patients with psoriasis (RR: 1.14, 95% confidence interval [CI]: 1.06–1.24, p = 0.0009) and psoriatic arthritis (RR: 2.20, 95% CI: 1.29–3.78, p = 0.004), the proportions of those with non-vascular dementia (RR: 1.13, 95% CI: 1.11–1.15, p < 0.00001) and vascular dementia (RR: 1.41, 95% CI: 1.09–1.82, p = 0.009) were higher than that among the patients without psoriasis. Those with dementia were also more likely to develop psoriasis, and those with severe psoriasis were less likely to die from dementia (RR: 1.88, 95% CI: 0.72–4.90, p = 0.020). The meta-regression analysis did not show any significant sources of heterogeneity. Conclusions: The patients with psoriasis and psoriatic arthritis show high prevalence of different types of dementia. Based on the findings of this study, dementia may not be considered a high-risk factor of death from severe psoriasis. However, identification of this potential risk allows for early intervention, thereby reducing comorbidities and deaths.
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Affiliation(s)
- Liu Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Si-Ting Chen
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hong-Jin Li
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Yan Qiang
- Department of Dermatology, Songjiang Hospital Affiliated to Shanghai Jiao Tong University, Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Ying Sun
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Ya-Qiong Zhou
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Meng Xing
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying Luo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yi Ru
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Jie Ding
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Le Kuai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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13
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Okan G, Baki AM, Yorulmaz E, Doğru-Abbasoğlu S, Vural P. A preliminary study about neurofilament light chain and tau protein levels in psoriasis: Correlation with disease severity. J Clin Lab Anal 2020; 35:e23564. [PMID: 32896023 PMCID: PMC7843295 DOI: 10.1002/jcla.23564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/26/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Studies investigating cognitive dysfunction in psoriatic patients remain inconclusive. OBJECTIVE To investigate the risk of cognitive decline in plaque-type psoriasis patients. METHODS Serum neurofilament light chain (NFL) and tau protein concentrations in 45 patients with plaque-type psoriasis and forty-five healthy controls were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS Mean homeostasis model assessment (HOMA-IR) values (6.82 vs 3.25) and serum levels of insulin (28.19 vs 15.71), NFL (5.74 vs 1.98), and tau (348.17 vs 207.30) in patients with psoriasis were found to be significantly higher than those of in healthy controls. There was a significant positive correlation between NFL and tau (r = .257, P = .015). There was significant correlation between NFL, tau and PASI (r = .310, P = .040) and (r = .383, P = .010), respectively. Significant correlations between NFL and insulin, TC, HDL-C, TG, VLDL-C, and BMI were found. NFL (9.38 vs 3.08) and tau (439.28 vs 281.58) concentrations and PASI values (23.94 vs 14.18) in patients with disease onset before 40 years were significantly higher than that of the patients with disease onset after 40 years. C-reactive protein (CRP) was significantly correlated with BMI (r = .449, P < .001), LDL-C (r = .240, P = .026), TG (r = .244, P = .024), and VLDL-C (r = .241, P = .025) in patients with psoriasis. CONCLUSIONS Increased serum NFL and tau protein levels and the presence of positive correlations between NFL, tau protein and PASI score show cognitive decline risk may be higher in moderate-to-severe psoriasis.
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Affiliation(s)
- Gokhan Okan
- Department of Dermatology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Adile Merve Baki
- Department of Biochemistry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Eda Yorulmaz
- Department of Biochemistry, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Semra Doğru-Abbasoğlu
- Department of Biochemistry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pervin Vural
- Department of Biochemistry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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14
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Lam M, Khorvash R, Drucker AM. Association between psoriasis and risk of dementia: A systematic review and meta-analysis. J Am Acad Dermatol 2020; 84:790-792. [PMID: 32446822 DOI: 10.1016/j.jaad.2020.05.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Megan Lam
- Michael G. DeGroote School of Medicine, Faculty of Medicine, Hamilton, Ontario, Canada
| | - Reza Khorvash
- Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Aaron M Drucker
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
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15
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Yen H, Yen H, Chi CC. Is psoriasis associated with dementia or cognitive impairment? A Critically Appraised Topic. Br J Dermatol 2020; 184:34-42. [PMID: 32162307 DOI: 10.1111/bjd.19025] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2020] [Indexed: 12/11/2022]
Abstract
CLINICAL QUESTION Is psoriasis associated with dementia or cognitive impairment? BACKGROUND Psoriasis is a multisystemic inflammatory disorder that has an unclear association with cognitive dysfunction. OBJECTIVES To conduct a Critically Appraised Topic that synthesizes the results from relevant observational studies. METHODS A systematic literature search of PubMed and Embase was conducted on 12 July 2019 to identify case-control, cross-sectional or cohort studies that investigated the association between psoriasis and cognitive impairment or dementia. Risk of bias was assessed for each study, and the results presented in a narrative synthesis. RESULTS Eleven studies were included for critical appraisal. Of the 11 studies, 10 compared a total of 16 574 psoriasis cases with over 45 078 controls for risk of dementia or cognitive impairment. One of the 11 studies evaluated 7118 patients with dementia for odds of psoriasis compared with 21 354 controls. Six studies were assessed to have higher risk of bias. Nine of the 11 included studies found a significant positive association between the two diseases, one study a null association, and one study an inverse association. DISCUSSION AND RECOMMENDATION Most of the 11 included studies found a positive association between psoriasis and either mild cognitive impairment or dementia. Brief cognitive assessments have been suggested to screen older patients with psoriasis who present with subjective cognitive complaints.
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Affiliation(s)
- H Yen
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - H Yen
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - C-C Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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16
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Balogh EA, Bashyam AM, Ghamrawi RI, Feldman SR. Emerging systemic drugs in the treatment of plaque psoriasis. Expert Opin Emerg Drugs 2020; 25:89-100. [PMID: 32192366 DOI: 10.1080/14728214.2020.1745773] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Psoriasis is a common, chronic inflammatory skin condition that affects 2-3% of the US population and represents a large psychosocial burden for patients. Over the last decade, highly effective targeted therapies for psoriasis have been developed - namely, those targeting interleukin (IL)-17 and IL-23. The success of biologic agents targeting IL-17 and IL-23 underscores the importance of the IL-23/T helper (Th)17 cell axis in psoriasis pathogenesis. Oral small molecule drugs - such as Janus kinase (JAK) inhibitors, tyrosine kinase 2 (TYK2) inhibitors, and fumaric acid esters (FAEs) - are also being investigated for the treatment of psoriasis. AREAS COVERED This article reviews systemic biologic and oral small molecule drugs currently undergoing clinical trials for the treatment of plaque psoriasis. EXPERT OPINION Many patients with psoriasis have mild disease, and many with mild disease do not seek medical care for their condition. Many patients with mild disease could be adequately treated with topical treatments and phototherapy; however, adherence and feasibility have often been an issue with these treatment types. There seems to be limited room for development of novel biologics, as the existing ones are extraordinarily safe, effective, and convenient with few injections. Patients would prefer a safe, effective oral treatment; however, JAK inhibitors seem unlikely to fill this role completely.
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Affiliation(s)
- Esther A Balogh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem, NC, USA
| | - Arjun M Bashyam
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem, NC, USA
| | - Rima I Ghamrawi
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem, NC, USA.,Department of Pathology, Wake Forest School of Medicine , Winston-Salem, NC, USA.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine , Winston-Salem, NC, USA.,Department of Dermatology, University of Southern Denmark , Odense, Denmark
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17
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Wu CY, Hu HY, Chou YJ, Li CP, Chang YT. Psoriasis is not a risk factor for dementia: a 12-year nationwide population-based cohort study. Arch Dermatol Res 2020; 312:657-664. [PMID: 32152723 DOI: 10.1007/s00403-020-02057-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/26/2020] [Indexed: 02/03/2023]
Abstract
Studies investigating the risk for dementia in psoriatic patients remain inconclusive. There are a limited number of population-based studies on the association between psoriasis and dementia. This study aims to investigate the risk for dementia in psoriatic patients. This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Research Database between 2000 and 2012. A total of 111,825 patients with psoriasis and 111,825 age-, sex-, and index date-matched controls were recruited. The hazard ratio (HR) for subsequent dementia in patients with psoriasis was analyzed using a Cox model and a Fine-Gray competing risk model. During 1,358,774 person-years of follow-up, 2688 patients developed dementia in the psoriatic cohort, and 2062 developed dementia in the control cohort. In the multivariate adjusted Cox model, the hazard ratio (HR) of psoriatic patients for dementia was 1.02 [95% confidence interval (CI) 0.96-1.09] relative to the controls. Psoriasis did not increase the risk for dementia (both vascular dementia and degenerative dementia). In the competing risk model, the HR of dementia was 0.96 (95% CI 0.90-1.02) for psoriatic patients. Compared to psoriatic patients who had not received phototherapy or systemic treatment, those psoriatic patients receiving phototherapy or systemic treatment had a lower risk for dementia. However, this phenomenon was not observed in psoriatic patients who were observed for longer than 6 years. Psoriasis was not found to be a risk factor for dementia. Phototherapy and systemic treatment might not have a protective effect against dementia in psoriatic patients.
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Affiliation(s)
- Chen-Yi Wu
- Department of Dermatology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan. .,Department of Public Health, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan. .,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan.
| | - Hsiao-Yun Hu
- Department of Public Health, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Department of Public Health, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chung-Pin Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan
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18
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No Difference in Cognitive Dysfunction Among Patients with ANCA-Associated Vasculitis, Rheumatoid Arthritis or Chronic Kidney Disease. J Int Neuropsychol Soc 2019; 25:595-602. [PMID: 31030697 DOI: 10.1017/s1355617719000262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To characterize cognitive function in patients with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) in comparison with other chronic conditions, and to investigate its association with disease activity, and other psychological factors. METHODS Cross-sectional study including patients with AAV, rheumatoid arthritis (RA) (n = 30), and chronic kidney disease (CKD) (n = 29). Patients underwent a standardized neuropsychological battery (NEUROPSI). Sleep quality, fatigue, depression, and anxiety levels were assessed. RESULTS A total of 60 patients with AAV were included, median age of 54 years, and disease duration of 5.6 years. Prevalence of cognitive dysfunction (CD) in AAV patients was similar to RA and CKD (35%, 40%, and 39.3%, respectively, p = .88). When AAV patients with (n = 21) and without (n = 39) CD were compared, significantly more patients with CD had high disease activity (67% vs. 31%, p = .009). Abnormal performance was more frequent in the executive functions in the three groups (45% AAV, 51.7% RA, and 50% CKD), followed by language (25%, 13.8%, and 25%, respectively). Verbal and visual attentional tests were more frequently impaired in patients from the CKD group (p = .021), and psychomotor functions were more frequently affected in AAV patients (p < .05). Hospital Anxiety and Depression Scale (HADS) total score (especially anxiety) was higher in patients with memory impairment than in those with normal memory function (M = 6.79, SD = 4.53 vs. M = 4.5, SD = 3.6, p < .01). Neither Sleep Quality Index nor fatigue scale scores differed between those cognitively impaired and not impaired. CONCLUSIONS No statistically significant differences were found in the frequency of CD among the three clinical populations. (JINS, 2019, 25, 595-602).
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19
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Deveci E, Kocacenk T, Şahan E, Yılmaz O, Öztürk A, Kırpınar İ. Oxidative stress and inflammatory response in patients with psoriasis; is there any relationship with psychiatric comorbidity and cognitive functions? PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1589176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Erdem Deveci
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - Tuba Kocacenk
- Abant İzzet Baysal Üniversitesi İzzet Baysal Ruh Sağlığı Ve Hastalıkları Eğitim Ve Araştırma, Hastanesi, Bolu, Turkey
| | - Ebru Şahan
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - Onur Yılmaz
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Öztürk
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - İsmet Kırpınar
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
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20
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Klimov E, Tretiakov A, Rudko O, Soboleva A, Danilin I, Korsunskaya I, Sobolev V. Psychodermatology: a molecular link between psoriasis and anxiety disorder. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Amanat M, Salehi M, Rezaei N. Neurological and psychiatric disorders in psoriasis. Rev Neurosci 2018; 29:805-813. [PMID: 29509545 DOI: 10.1515/revneuro-2017-0108] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/26/2018] [Indexed: 12/26/2022]
Abstract
Psoriasis used to be known as a skin disorder; however, it can now be considered as a systemic disease with the involvement of multiple organs. Neurological and psychiatric disorders are some of the associated problems that can be observed in patients with psoriasis. Stroke, multiple sclerosis, seizure, migraine, restless leg syndrome, Parkinson's disease, Guillain-Barré syndrome, and myasthenia gravis are the reported neurological diseases, while depression, bipolar mood disorder, anxiety, psychosis, cognitive impairment, personality disorders, sexual disorders, sleep disturbance, and eating disorders are the recognized psychiatric presentations in patients with psoriasis. Herein, the neurological and psychiatric disorders of psoriasis are described.
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Affiliation(s)
- Man Amanat
- NeuroImmunology Research Association (NIRA), Universal Scientific Education and Research Network (USERN), Tehran 14194, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran 1417755331, Iran
| | - Mona Salehi
- NeuroImmunology Research Association (NIRA), Universal Scientific Education and Research Network (USERN), Tehran 14194, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran 1417755331, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Dr. Gharib St, Keshavarz Blvd, Tehran 14194, Iran.,Department of Immunology and Biology, School of Medicine, Tehran University of Medical Sciences, Tehran 14155-6447, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Boston, MA 1419733151, USA
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22
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Panasiti MS, Ponsi G, Monachesi B, Lorenzini L, Panasiti V, Aglioti SM. Cognitive load and emotional processing in psoriasis: a thermal imaging study. Exp Brain Res 2018; 237:211-222. [PMID: 30374785 DOI: 10.1007/s00221-018-5416-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/24/2018] [Indexed: 10/28/2022]
Abstract
Psoriasis is a chronic dermatologic disease which is frequently associated with psychological distress. Although studies suggest a relationship between this condition and difficulties in emotion regulation, behavioral and physiological evidence about this link is scarce. We measured implicit emotion regulation abilities of psoriasis patients and a healthy control group by examining the impact of distracting emotional (positive, negative or neutral) images on a working memory task ("Emotional N-Back") which could present high (2-back) or low (1-back) cognitive workload. Moreover, we used Functional Infrared Thermal Imaging to record participants' facial temperature and obtain a measure of the activation of the autonomic system. Rising of temperature over the peri-orbital areas and the nose tip are believed to reflect the activation and the de-activation of the sympathetic system, respectively. Patients scored higher than controls on the "Lack of emotional clarity" sub-scale of the Difficulties in Emotion Regulation Scale. Compared to controls, who performed much better in the low vs. high cognitive load condition, patients showed a smaller accuracy difference between the two conditions. Moreover, patients showed less sympathetic (lower peri-orbital and higher nasal tip temperature) activity (especially in the negative and neutral blocks) during the high vs. low cognitive load condition, suggesting that the former condition might be less emotionally demanding for them. Patients benefit more than controls from the load-dependent interference effect when dealing with emotional information; thus, therapeutic techniques aiming at teaching how to use cognitive strategies to downregulate emotions might be particularly appropriated for them.
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Affiliation(s)
- Maria Serena Panasiti
- Department of Psychology, Sapienza University of Rome, Via dei Marsi, 78, 00185, Rome, Italy. .,IRCCS Santa Lucia Foundation, Rome, Italy.
| | - Giorgia Ponsi
- Department of Psychology, Sapienza University of Rome, Via dei Marsi, 78, 00185, Rome, Italy.,IRCCS Santa Lucia Foundation, Rome, Italy
| | - Bianca Monachesi
- Department of Psychology, Sapienza University of Rome, Via dei Marsi, 78, 00185, Rome, Italy.,IRCCS Santa Lucia Foundation, Rome, Italy
| | - Luigi Lorenzini
- Department of Psychology, Sapienza University of Rome, Via dei Marsi, 78, 00185, Rome, Italy.,IRCCS Santa Lucia Foundation, Rome, Italy
| | - Vincenzo Panasiti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Salvatore Maria Aglioti
- Department of Psychology, Sapienza University of Rome, Via dei Marsi, 78, 00185, Rome, Italy.,IRCCS Santa Lucia Foundation, Rome, Italy
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23
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Pezzolo E, Mutlu U, Vernooij MW, Dowlatshahi EA, Gisondi P, Girolomoni G, Nijsten T, Ikram MA, Wakkee M. Psoriasis is not associated with cognition, brain imaging markers, and risk for dementia: The Rotterdam Study. J Am Acad Dermatol 2018; 85:671-680. [PMID: 30092331 DOI: 10.1016/j.jaad.2018.07.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/17/2018] [Accepted: 07/26/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Based on increased cardiometabolic comorbidities, inflammation, and an overlap in genetics with Alzheimer disease, psoriasis patients might be at risk for cognitive dysfunction and dementia. OBJECTIVE To compare cognition, magnetic resonance imaging (MRI)-markers, and dementia risk in psoriasis and nonpsoriasis participants in the population-based Rotterdam Study. METHODS We identified 318 psoriasis and 9678 nonpsoriasis participants (mean age 66.1 years, 58% women). The association of psoriasis with cognitive function, mild cognitive impairment, and MRI-markers of brain damage was examined by linear and logistic regression. Dementia risk was calculated using Cox regression. Models were adjusted for age, sex, education, and cardiovascular risk factors. RESULTS Cognitive test scores and volumetric, microstructural, focal measures on brain MRI did not differ between psoriasis (28% systemic and ultraviolet treatment) and nonpsoriasis participants, and psoriasis was not associated with mild cognitive impairment (adjusted odd ratio 0.87, 95% confidence interval 0.53-1.43). During 115.000 person-years of follow-up, 810 incident dementia cases (15 among psoriasis patients) occurred. After adjusting for confounders, psoriasis was associated with a lower risk of developing dementia (adjusted hazard ratio 0.50, 95% confidence interval 0.28-0.91). LIMITATIONS Limited dementia cases among psoriasis patients. CONCLUSION In this population-based study, psoriasis was not associated with preclinical markers or higher dementia risk.
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Affiliation(s)
- Elena Pezzolo
- Department of Dermatology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands; Department of Medicine, Section of Dermatology and Venerology, University of Verona, Verona, Italy
| | - Unal Mutlu
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands
| | - Emmilia A Dowlatshahi
- Department of Dermatology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands
| | - Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venerology, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venerology, University of Verona, Verona, Italy
| | - Tamar Nijsten
- Department of Dermatology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands.
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Innamorati M, Quinto RM, Lester D, Iani L, Graceffa D, Bonifati C. Cognitive impairment in patients with psoriasis: A matched case-control study. J Psychosom Res 2018; 105:99-105. [PMID: 29332640 DOI: 10.1016/j.jpsychores.2017.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/06/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In the past decade, a few studies have suggested that psoriasis could be associated with the presence of mild cognitive deficits. OBJECTIVES The aim of the present matched case-control study was to investigate several cognitive domains (executive functions, verbal memory, attention, and language) in a sample of outpatients with psoriasis. We also investigated whether cognitive impairment was associated with poor health-related quality of life (HRQoL) in patients with psoriasis. METHODS Fifty adult outpatients and 50 age- and sex-matched healthy controls were administered a battery of neuropsychological tests investigating major cognitive domains, psychopathology (anxiety and depression), alexithymia, and HRQoL. RESULTS At the bivariate level, psoriasis patients (compared to healthy controls) performed worse on most of the neuropsychological tests, and they also reported more anxiety and depressive symptoms, higher scores for alexithymia, and worse physical and mental health. At the multivariate level, cognitive performance was independently associated with psoriasis even when controlling for psychopathology and alexithymia. CONCLUSIONS Patients with psoriasis show impaired cognitive performance, high levels of anxiety and depression, and impaired quality of life. Based on the current results, clinicians should assess the presence of psychological symptoms in their patients and evaluate whether the presence of cognitive deficits is limiting the patients' ability to cope with the disease.
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Affiliation(s)
- Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy.
| | - Rossella M Quinto
- Department of Human Sciences, European University of Rome, Rome, Italy
| | | | - Luca Iani
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Dario Graceffa
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Claudio Bonifati
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
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25
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Wang H, Tan X, Xu J, Li H, Wang M, Chen S, Yang X, Liu Y, Wang F. Negative correlation between CSF lactate levels and MoCA scores in male Chinese subjects. Psychiatry Res 2017; 255:49-51. [PMID: 28528240 DOI: 10.1016/j.psychres.2017.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/13/2017] [Accepted: 05/11/2017] [Indexed: 11/16/2022]
Abstract
Lactate is a product of glycolysis by astrocytes and can be generated as a primary metabolic energy source by neurons. Lactate plays multifunctional role in human brain energy metabolism and cognitive function. However, no direct evidence demonstrated the link between lactate and cognition in normal condition. In the present study, concentrations of lactate in cerebrospinal fluid (CSF) and peripheral blood were measured to investigate the association of lactate with cognitive ability, which was assessed by Montreal Cognitive Assessment (MoCA), in 99 male Chinese subjects. Correlation analyses revealed that serum lactate levels were negatively correlated with age, and CSF lactate levels were negatively correlated with MoCA scores after Box-Cox transformations. But no correlation was found between serum lactate levels and MoCA scores after Box-Cox transformations. In conclusion, the results indicate that CSF lactate levels were negatively correlated with MoCA scores in male Chinese subjects.
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Affiliation(s)
- Haijun Wang
- Department of Pathology, Xinxiang Medical University, Xinxiang 453003, China
| | - Xiaohua Tan
- College of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Jinzhong Xu
- College of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China; The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling 317500, China
| | - Hui Li
- Psychosomatic Medicine Research Division, Inner Mongolia Medical University, Huhhot 010110, China
| | - Meiling Wang
- Psychosomatic Medicine Research Division, Inner Mongolia Medical University, Huhhot 010110, China
| | - Suling Chen
- The Seventh People's Hospital of Wenzhou, Wenzhou 325005, China
| | - Xiaoyu Yang
- Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yanlong Liu
- College of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China.
| | - Fan Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100035, China; Second Affiliated Hospital of Xinjiang Medical University, Urumqi 830028, China.
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Chen Q, Zhou H, Yang Y, Chi M, Xie N, Zhang H, Deng X, Leavesley D, Shi H, Xie Y. Investigating the potential of Oxymatrine as a psoriasis therapy. Chem Biol Interact 2017; 271:59-66. [PMID: 28450041 DOI: 10.1016/j.cbi.2017.04.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/24/2017] [Indexed: 12/29/2022]
Abstract
Psoriasis vulgaris is a chronic inflammatory skin disease, stubbornly intractable, with substantial consequences for patient physical and mental welfare. Approaches currently available to treat psoriasis are not satisfactory due to undesirable side-effects or expense. Psoriasis is characterized by hyperproliferation and inflammation. Oxymatrine, an active component extracted from Sophora flavescens, has been demonstrated to possess anti-proliferation, anti-inflammatory, anti-tumorigenic, immune regulation and pro-apoptotic properties. This investigation presents a detailed retrospective review examining the effect of Oxymatrine on psoriasis and investigates the mechanisms underlying patient responses to Oxymatrine. We confirm that Oxymatrine administration significantly reduced the Psoriasis Area Severity Index score, with high efficacy compared to the control group. In addition, we have found that Oxymatrine significantly inhibits the viability, proliferation and differentiation of human keratinocyte in vitro. Immunohistochemical analysis indicates Oxymatrine significantly suppresses the expression of Pan-Cytokeratin, p63 and keratin 10. The results indicate that the suppression of p63 expression may lead to the anti-proliferation effect of Oxymatrine on human skin keratinocytes. Oxymatrine does not affect the formation of basement membrane, which is very important to maintain the normal function of human skin keratinocytes. In summary, Oxymatrine offers an effective, economical, and safe treatment for patients presenting with intractable psoriasis vulgaris.
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Affiliation(s)
- Qian Chen
- Ningxia Medical University, Ningxia, China
| | - Hui Zhou
- Department of Dermatology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Yinxue Yang
- President of General Hospital of Ningxia Medical University, Ningxia, China
| | - Mingwei Chi
- Medical Affairs Office, General Hospital of Ningxia Medical University, Ningxia, China
| | - Nan Xie
- Tissue Organ Bank & Tissue Engineering Centre, General Hospital of Ningxia Medical University, Ningxia, China
| | - Hong Zhang
- Tissue Organ Bank & Tissue Engineering Centre, General Hospital of Ningxia Medical University, Ningxia, China
| | | | - David Leavesley
- Tissue Organ Bank & Tissue Engineering Centre, General Hospital of Ningxia Medical University, Ningxia, China; Tissue Technologies, Institute of Medical Biology, Agency for Science, Technology and Research, Singapore; Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore; School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Lee Kong Chain School of Medicine, Nanyang Technological University, Singapore
| | - Huijuan Shi
- Department of Dermatology, General Hospital of Ningxia Medical University, Ningxia, China.
| | - Yan Xie
- Tissue Organ Bank & Tissue Engineering Centre, General Hospital of Ningxia Medical University, Ningxia, China; School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
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Abstract
While some autoimmune disorders remain extremely rare, others largely predominate the epidemiology of human autoimmunity. Notably, these include psoriasis, diabetes, vitiligo, thyroiditis, rheumatoid arthritis and multiple sclerosis. Thus, despite the quasi-infinite number of "self" antigens that could theoretically trigger autoimmune responses, only a limited set of antigens, referred here as superautoantigens, induce pathogenic adaptive responses. Several lines of evidence reviewed in this paper indicate that, irrespective of the targeted organ (e.g. thyroid, pancreas, joints, brain or skin), a significant proportion of superautoantigens are highly expressed in the synaptic compartment of the central nervous system (CNS). Such an observation applies notably for GAD65, AchR, ribonucleoproteins, heat shock proteins, collagen IV, laminin, tyrosine hydroxylase and the acetylcholinesterase domain of thyroglobulin. It is also argued that cognitive alterations have been described in a number of autoimmune disorders, including psoriasis, rheumatoid arthritis, lupus, Crohn's disease and autoimmune thyroiditis. Finally, the present paper points out that a great majority of the "incidental" autoimmune conditions notably triggered by neoplasms, vaccinations or microbial infections are targeting the synaptic or myelin compartments. On this basis, the concept of an immunological homunculus, proposed by Irun Cohen more than 25 years ago, is extended here in a model where physiological autoimmunity against brain superautoantigens confers both: i) a crucial evolutionary-determined advantage via cognition-promoting autoimmunity; and ii) a major evolutionary-determined vulnerability, leading to the emergence of autoimmune disorders in Homo sapiens. Moreover, in this theoretical framework, the so called co-development/co-evolution model, both the development (at the scale of an individual) and evolution (at the scale of species) of the antibody and T-cell repertoires are coupled to those of the neural repertoires (i.e. the distinct neuronal populations and synaptic circuits supporting cognitive and sensorimotor functions). Clinical implications and future experimental insights are also presented and discussed.
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Affiliation(s)
- Serge Nataf
- Bank of Tissues and Cells, Lyon University Hospital (Hospices Civils de Lyon), CarMeN Laboratory, INSERM 1060, INRA 1397, INSA Lyon, Université Claude Bernard Lyon-1, Lyon, F-69000, France
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