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Zerr I, Ladogana A, Mead S, Hermann P, Forloni G, Appleby BS. Creutzfeldt-Jakob disease and other prion diseases. Nat Rev Dis Primers 2024; 10:14. [PMID: 38424082 DOI: 10.1038/s41572-024-00497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
Prion diseases share common clinical and pathological characteristics such as spongiform neuronal degeneration and deposition of an abnormal form of a host-derived protein, termed prion protein. The characteristic features of prion diseases are long incubation times, short clinical courses, extreme resistance of the transmissible agent to degradation and lack of nucleic acid involvement. Sporadic and genetic forms of prion diseases occur worldwide, of which genetic forms are associated with mutations in PRNP. Human to human transmission of these diseases has occurred due to iatrogenic exposure, and zoonotic forms of prion diseases are linked to bovine disease. Significant progress has been made in the diagnosis of these disorders. Clinical tools for diagnosis comprise brain imaging and cerebrospinal fluid tests. Aggregation assays for detection of the abnormally folded prion protein have a clear potential to diagnose the disease in peripherally accessible biofluids. After decades of therapeutic nihilism, new treatment strategies and clinical trials are on the horizon. Although prion diseases are relatively rare disorders, understanding their pathogenesis and mechanisms of prion protein misfolding has significantly enhanced the field in research of neurodegenerative diseases.
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Affiliation(s)
- Inga Zerr
- National Reference Center for CJD Surveillance, Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany.
| | - Anna Ladogana
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Simon Mead
- MRC Prion Unit at UCL, Institute of Prion Diseases, London, UK
| | - Peter Hermann
- National Reference Center for CJD Surveillance, Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany
| | - Gianluigi Forloni
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Brian S Appleby
- Departments of Neurology, Psychiatry and Pathology, Case Western Reserve University, Cleveland, OH, USA
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Nihat A, Ranson JM, Harris D, McNiven K, Mok T, Rudge P, Collinge J, Llewellyn DJ, Mead S. Development of prognostic models for survival and care status in sporadic Creutzfeldt-Jakob disease. Brain Commun 2022; 4:fcac201. [PMID: 35974795 PMCID: PMC9374480 DOI: 10.1093/braincomms/fcac201] [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: 02/08/2022] [Revised: 04/04/2022] [Accepted: 08/01/2022] [Indexed: 12/03/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease, the most common human prion disease, typically presents as a rapidly progressive dementia and has a highly variable prognosis. Despite this heterogeneity, clinicians need to give timely advice on likely prognosis and care needs. No prognostic models have been developed that predict survival or time to increased care status from the point of diagnosis. We aimed to develop clinically useful prognostic models with data from a large prospective observational cohort study. Five hundred and thirty-seven patients were visited by mobile teams of doctors and nurses from the National Health Service National Prion Clinic within 5 days of notification of a suspected diagnosis of sporadic Creutzfeldt-Jakob disease, enrolled to the study between October 2008 and March 2020, and followed up until November 2020. Prediction of survival over 10-, 30- and 100-day periods was the main outcome. Escalation of care status over the same time periods was a secondary outcome for a subsample of 113 patients with low care status at initial assessment. Two hundred and eighty (52.1%) patients were female and the median age was 67.2 (interquartile range 10.5) years. Median survival from initial assessment was 24 days (range 0–1633); 414 patients died within 100 days (77%). Ten variables were included in the final prediction models: sex; days since symptom onset; baseline care status; PRNP codon 129 genotype; Medical Research Council Prion Disease Rating Scale, Motor and Cognitive Examination Scales; count of MRI abnormalities; Mini-Mental State Examination score and categorical disease phenotype. The strongest predictor was PRNP codon 129 genotype (odds ratio 6.65 for methionine homozygous compared with methionine-valine heterozygous; 95% confidence interval 3.02–14.68 for 30-day mortality). Of 113 patients with lower care status at initial assessment, 88 (78%) had escalated care status within 100 days, with a median of 35 days. Area under the curve for models predicting outcomes within 10, 30 and 100 days was 0.94, 0.92 and 0.91 for survival, and 0.87, 0.87 and 0.95 for care status escalation, respectively. Models without PRNP codon 129 genotype, which is not immediately available at initial assessment, were also highly accurate. We have developed a model that can accurately predict survival and care status escalation in sporadic Creutzfeldt-Jakob disease patients using clinical, imaging and genetic data routinely available in a specialist national referral service. The utility and generalizability of these models to other settings could be prospectively evaluated when recruiting to clinical trials and providing clinical care.
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Affiliation(s)
- Akın Nihat
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases , Cleveland Street, London W1W 7FF , UK
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust , London WC1N 3BG , UK
| | - Janice M Ranson
- College of Medicine and Health, University of Exeter , Exeter EX1 2HZ , UK
- Deep Dementia Phenotyping Network , Exeter EX1 2LU , UK
| | - Dominique Harris
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases , Cleveland Street, London W1W 7FF , UK
| | - Kirsty McNiven
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust , London WC1N 3BG , UK
| | - TzeHow Mok
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases , Cleveland Street, London W1W 7FF , UK
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust , London WC1N 3BG , UK
| | - Peter Rudge
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases , Cleveland Street, London W1W 7FF , UK
| | - John Collinge
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases , Cleveland Street, London W1W 7FF , UK
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust , London WC1N 3BG , UK
| | - David J Llewellyn
- College of Medicine and Health, University of Exeter , Exeter EX1 2HZ , UK
- Deep Dementia Phenotyping Network , Exeter EX1 2LU , UK
- Alan Turing Institute , London NW1 2DB , UK
| | - Simon Mead
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases , Cleveland Street, London W1W 7FF , UK
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust , London WC1N 3BG , UK
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Carneiro AAM, Esmeraldo MA, Silva DEDLE, Ribeiro EML. Creutzfeldt-Jakob disease: literature review based on three case reports. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2021-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT. Creutzfeldt-Jakob disease (CJD) is one of the transmissible spongiform encephalopathies that lead to rapidly progressive dementia. CJD has a low prevalence, and the average survival is only 1 year after the onset of symptoms. As the patients with CJD develop rapidly progressive dementia, associated with myoclonus, visual or cerebellar problems, pyramidal or extrapyramidal features, and akinetic mutism, the hypothesis of CJD must be raised. Classic magnetic resonance imaging (MRI) findings are hypersignals in the caudate nucleus, putamen, and cortical region. CJD must be considered a differential diagnosis of other types of dementia, and there is no effective treatment for this disease. In this article, we present a literature review based on the report of three cases of the sporadic form of this disease.
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Joseph A, Mushtaq H, Zakhia G, Rohde J, Whiting A, Jama AB, Khedr A, Jain NK, Khan SA. A Rare Case of Creutzfeldt-Jakob Disease With Alcohol Use Disorder and Review of Literature. Cureus 2022; 14:e24812. [PMID: 35686246 PMCID: PMC9170237 DOI: 10.7759/cureus.24812] [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] [Accepted: 05/07/2022] [Indexed: 11/20/2022] Open
Abstract
Sporadic Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative disorder, accounting for a majority of the sporadic prion disease burden. This disorder rapidly progresses and is often fatal with no known cure. Initial diagnosis may be delayed due to its varied presentations, which can include psychiatric changes (behavioural and mood variances), visual and auditory hallucinations, cerebellar dysfunction, and pain, occurring in isolation in many cases. Due to the nonspecific complaints, accurate diagnosis can be challenging. CJD exhibits symptoms similar to other neuropsychiatric illnesses; however, only a few reports have been published concerning the association between CJD and alcohol-related illnesses. This case report demonstrates the challenge of diagnosing this disorder early in the clinical course given the variable presentation, especially in a patient with a history of an alcohol use disorder, falls, and cognitive decline.
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Affiliation(s)
- Abraham Joseph
- Hospital Medicine, Mayo Clinic Health System, Fairmont, USA
| | - Hisham Mushtaq
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
| | | | - Jonathan Rohde
- Hospital Medicine, Mayo Clinic Health System, Fairmont, USA
| | - Adria Whiting
- Family Medicine, Mayo Clinic Health System, Fairmont, USA
| | - Abbas B Jama
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
| | - Anwar Khedr
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
| | - Nitesh K Jain
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
| | - Syed Anjum Khan
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
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Harrison KL, Garrett SB, Gilissen J, Terranova MJ, Bernstein Sideman A, Ritchie CS, Geschwind MD. Developing neuropalliative care for sporadic Creutzfeldt-Jakob Disease. Prion 2022; 16:23-39. [PMID: 35239456 PMCID: PMC8896185 DOI: 10.1080/19336896.2022.2043077] [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] [Indexed: 11/24/2022] Open
Abstract
We aimed to identify targets for neuropalliative care interventions in sporadic Creutzfeldt-Jakob disease by examining characteristics of patients and sources of distress and support among former caregivers. We identified caregivers of decedents with sporadic Creutzfeldt-Jakob disease from the University of California San Francisco Rapidly Progressive Dementia research database. We purposively recruited 12 caregivers for in-depth interviews and extracted associated patient data. We analysed interviews using the constant comparison method and chart data using descriptive statistics. Patients had a median age of 70 (range: 60–86) years and disease duration of 14.5 months (range 4–41 months). Caregivers were interviewed a median of 22 (range 11–39) months after patient death and had a median age of 59 (range 45–73) years. Three major sources of distress included (1) the unique nature of sporadic Creutzfeldt-Jakob disease; (2) clinical care issues such as difficult diagnostic process, lack of expertise in sporadic Creutzfeldt-Jakob disease, gaps in clinical systems, and difficulties with end-of-life care; and (3) caregiving issues, including escalating responsibilities, intensifying stress, declining caregiver well-being, and care needs surpassing resources. Two sources of support were (1) clinical care, including guidance from providers about what to expect and supportive relationships; and (2) caregiving supports, including connection to persons with experience managing Creutzfeldt-Jakob disease, instrumental support, and social/emotional support. The challenges and supports described by caregivers align with neuropalliative approaches and can be used to develop interventions to address needs of persons with sporadic Creutzfeldt-Jakob disease and their caregivers.
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Affiliation(s)
- Krista L Harrison
- Division of Geriatrics, University of California, San Francisco, USA.,Philip R. University of California, San Francisco, USA.,Global Brain Health Institute, University of California, San Francisco, California, USA
| | | | - Joni Gilissen
- Global Brain Health Institute, University of California, San Francisco, California, USA.,End-of-Life Care Research Group, Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (Vub), Belgium
| | - Michael J Terranova
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Philip R. University of California, San Francisco, USA.,Global Brain Health Institute, University of California, San Francisco, California, USA.,Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, California, USA
| | - Christine S Ritchie
- Division of Geriatrics, University of California, San Francisco, USA.,Global Brain Health Institute, University of California, San Francisco, California, USA.,The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, USA
| | - Michael D Geschwind
- Global Brain Health Institute, University of California, San Francisco, California, USA.,Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
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Thekkekarott Kuruvila A, Ranawat N, Hegde N, Arora A. A Case of Rapidly Progressive Dementia. Cureus 2022; 14:e22507. [PMID: 35371628 PMCID: PMC8947950 DOI: 10.7759/cureus.22507] [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] [Accepted: 02/22/2022] [Indexed: 12/02/2022] Open
Abstract
Creutzfeldt-Jakob disease (CJD) is a very rare neurodegenerative disorder that usually presents as rapidly progressive dementia with an extremely poor prognosis. The diagnosis of CJD can be extremely challenging due to its rarity, manifestation with non-specific neurological symptoms, associated broad differentials, and a need for extensive workup. Awareness of disease-specific biomarkers, radiological signs, and diagnostic criteria are crucial for timely diagnosis. Here, we report a case of CJD, which presented as an atypical movement disorder that progressed to dementia and failure to thrive within a few weeks of presentation.
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Sharma N, Wang L, Namboodiri H. Creutzfeldt-Jakob Disease Following Kidney Transplantation. Cureus 2022; 14:e21632. [PMID: 35228978 PMCID: PMC8878572 DOI: 10.7759/cureus.21632] [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] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Neurologic complications after kidney transplantation are frequent and related to immunosuppressive therapy and vintage dialysis time, including comorbidities such as diabetes, hypertension, and cardiovascular diseases. Creutzfeldt-Jakob disease (CJD) is a very rare and rapidly fatal neurodegenerative disorder. Kidney transplant recipients present with mixed and complex neuropsychiatric manifestations, which makes diagnosis challenging. This case highlights the importance of enhancing awareness of the clinical presentation and timely diagnosis of this rare, fatal neurodegenerative disorder.
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Figgie MP, Appleby BS. Clinical Use of Improved Diagnostic Testing for Detection of Prion Disease. Viruses 2021; 13:v13050789. [PMID: 33925126 PMCID: PMC8146465 DOI: 10.3390/v13050789] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
Prion diseases are difficult to recognize as many symptoms are shared among other neurologic pathologies and the full spectra of symptoms usually do not appear until late in the disease course. Additionally, many commonly used laboratory markers are non-specific to prion disease. The recent introduction of second-generation real time quaking induced conversion (RT-QuIC) has revolutionized pre-mortem diagnosis of prion disease due to its extremely high sensitivity and specificity. However, RT-QuIC does not provide prognostic data and has decreased diagnostic accuracy in some rarer, atypical prion diseases. The objective of this review is to provide an overview of the current clinical utility of fluid-based biomarkers, neurodiagnostic testing, and brain imaging in the diagnosis of prion disease and to suggest guidelines for their clinical use, with a focus on rarer prion diseases with atypical features. Recent advancements in laboratory-based testing and imaging criteria have shown improved diagnostic accuracy and prognostic potential in prion disease, but because these diagnostic tests are not sensitive in some prion disease subtypes and diagnostic test sensitivities are unknown in the event that CWD transmits to humans, it is important to continue investigations into the clinical utility of various testing modalities.
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Affiliation(s)
- Mark P. Figgie
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Brian S. Appleby
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA;
- National Prion Disease Pathology Surveillance Center, Case Western Reserve University, Cleveland, OH 44106, USA
- Correspondence:
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Abstract
Recent advances in understanding of the molecular biology of prion diseases and improved clinical diagnostic techniques might allow researchers to think about therapeutic trials in Creutzfeldt-Jakob disease (CJD) patients. Some attempts have been made in the past and various compounds have been tested in single case reports and patient series. Controlled trials are rare. However, in the past few years, it has been demonstrated that clinical trials are feasible. The clinicians might face several specific problems when evaluating the efficacy of the drug in CJD, such as rareness of the disease, lack of appropriate preclinical tests and heterogeneous clinical presentation in humans. These problems have to be carefully addressed in future.
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Affiliation(s)
- Saima Zafar
- Clinical Dementia Center and German Center for Neurodegenerative Diseases, Department of Neurology, Georg-August University, University Medical Center Göttingen, Göttingen, Germany; Biomedical Engineering and Sciences Department, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology, Islamabad, Pakistan
| | - Aneeqa Noor
- Clinical Dementia Center and German Center for Neurodegenerative Diseases, Department of Neurology, Georg-August University, University Medical Center Göttingen, Göttingen, Germany
| | - Inga Zerr
- Clinical Dementia Center and German Center for Neurodegenerative Diseases, Department of Neurology, Georg-August University, University Medical Center Göttingen, Göttingen, Germany.
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