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Björklund A, Barker RA. The basal forebrain cholinergic system as target for cell replacement therapy in Parkinson's disease. Brain 2024; 147:1937-1952. [PMID: 38279949 PMCID: PMC11146424 DOI: 10.1093/brain/awae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/19/2023] [Accepted: 01/19/2024] [Indexed: 01/29/2024] Open
Abstract
In recent years there has been a renewed interest in the basal forebrain cholinergic system as a target for the treatment of cognitive impairments in patients with Parkinson's disease, due in part to the need to explore novel approaches to treat the cognitive symptoms of the disease and in part to the development of more refined imaging tools that have made it possible to monitor the progressive changes in the structure and function of the basal forebrain system as they evolve over time. In parallel, emerging technologies allowing the derivation of authentic basal forebrain cholinergic neurons from human pluripotent stem cells are providing new powerful tools for the exploration of cholinergic neuron replacement in animal models of Parkinson's disease-like cognitive decline. In this review, we discuss the rationale for cholinergic cell replacement as a potential therapeutic strategy in Parkinson's disease and how this approach can be explored in rodent models of Parkinson's disease-like cognitive decline, building on insights gained from the extensive animal experimental work that was performed in rodent and primate models in the 1980s and 90s. Although therapies targeting the cholinergic system have so far been focused mainly on patients with Alzheimer's disease, Parkinson's disease with dementia may be a more relevant condition. In Parkinson's disease with dementia, the basal forebrain system undergoes progressive degeneration and the magnitude of cholinergic cell loss has been shown to correlate with the level of cognitive impairment. Thus, cell therapy aimed to replace the lost basal forebrain cholinergic neurons represents an interesting strategy to combat some of the major cognitive impairments in patients with Parkinson's disease dementia.
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Affiliation(s)
- Anders Björklund
- Wallenberg Neuroscience Center, Department of Experimental Medical Science, Lund University, 221 84 Lund, Sweden
| | - Roger A Barker
- Wellcome MRC Cambridge Stem Cell Institute and John van Geest Centre for Brain Repair Department of Clinical Neuroscience, University of Cambridge, Cambridge CB2 0PY, UK
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2
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Hamed SA, Hadad AFE. The effect of anticholinergic drugs on cognition of patients with Parkinson's disease: a cohort study from the Egyptian population. Expert Rev Clin Pharmacol 2024:1-11. [PMID: 38781022 DOI: 10.1080/17512433.2024.2359955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/22/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Cognitive dysfunction is a non-motor manifestation of Parkinson's disease (PD). We aimed to determine the frequency and patterns of cognitive dysfunction in treated patients with PD and their predictors. RESEARCH DESIGN AND METHODS This study included 80 patients (male = 48; female = 32) and 30 healthy individuals. They underwent neuropsychiatric evaluations. Measurements included Beck's depression inventory - II (BDI-II), mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). RESULTS Patients had mean age of 55.56 ± 9.06 yrs, duration of PD of 4.86 ± 2.71 yrs and Hoehn and Yahr Scoring of 2.19 ± 0.89. They were on levodopa/carbidopa therapy and adjuvant therapy with benztropine mesylate, an anticholinergic drug, (n = 51) or amantadine sulfate, a dopaminergic drug, (n = 29). Sixteen (20%) had moderate depressive symptoms. Mild and moderate cognitive impairments were reported in 38.8% and 28.8% (by MMSE) and 46.3% and 31.3% (by MoCA). Patients had lower global cognitive scoring (p = 0.0001) and scorings of different cognitive functions (naming, attention, language, abstraction, memory and orientation) than controls. Patients treated with benztropine had lower cognition than with amantadine. Correlation analyses showed that lower cognition was only associated with chronic PD and its treatment (p = 0.0001). CONCLUSIONS Cognitive dysfunction is common with PD (77.5%) particularly with anticholinergic drugs. De-prescription of anticholinergics is recommended for patients with PD.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - Ali Farrag El Hadad
- Department of Neurology and Psychiatry, Al Azhar University Hospital, Assiut, Egypt
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3
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Gritton HJ, Booth V, Howe WM. Special issue on cholinergic signalling. Eur J Neurosci 2024; 59:2131-2137. [PMID: 38679811 DOI: 10.1111/ejn.16369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Howard J Gritton
- Department of Comparative Biosciences, Bioengineering, and Psychology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Victoria Booth
- Departments of Mathematics and Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - William M Howe
- School of Neuroscience, Virginia Tech, Blacksburg, VA, USA
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Radlicka-Borysewska A, Jabłońska J, Lenarczyk M, Szumiec Ł, Harda Z, Bagińska M, Barut J, Pera J, Kreiner G, Wójcik DK, Rodriguez Parkitna J. Non-motor symptoms associated with progressive loss of dopaminergic neurons in a mouse model of Parkinson's disease. Front Neurosci 2024; 18:1375265. [PMID: 38745938 PMCID: PMC11091341 DOI: 10.3389/fnins.2024.1375265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Parkinson's disease (PD) is characterized by three main motor symptoms: bradykinesia, rigidity and tremor. PD is also associated with diverse non-motor symptoms that may develop in parallel or precede motor dysfunctions, ranging from autonomic system dysfunctions and impaired sensory perception to cognitive deficits and depression. Here, we examine the role of the progressive loss of dopaminergic transmission in behaviors related to the non-motor symptoms of PD in a mouse model of the disease (the TIF-IADATCreERT2 strain). We found that in the period from 5 to 12 weeks after the induction of a gradual loss of dopaminergic neurons, mild motor symptoms became detectable, including changes in the distance between paws while standing as well as the swing speed and step sequence. Male mutant mice showed no apparent changes in olfactory acuity, no anhedonia-like behaviors, and normal learning in an instrumental task; however, a pronounced increase in the number of operant responses performed was noted. Similarly, female mice with progressive dopaminergic neuron degeneration showed normal learning in the probabilistic reversal learning task and no loss of sweet-taste preference, but again, a robustly higher number of choices were performed in the task. In both males and females, the higher number of instrumental responses did not affect the accuracy or the fraction of rewarded responses. Taken together, these data reveal discrete, dopamine-dependent non-motor symptoms that emerge in the early stages of dopaminergic neuron degeneration.
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Affiliation(s)
- Anna Radlicka-Borysewska
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Judyta Jabłońska
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Michał Lenarczyk
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Łukasz Szumiec
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Zofia Harda
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Monika Bagińska
- Department of Brain Biochemistry, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Justyna Barut
- Department of Brain Biochemistry, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Joanna Pera
- Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - Grzegorz Kreiner
- Department of Brain Biochemistry, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Daniel K. Wójcik
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
- Laboratory of Neuroinformatics, Nencki Institute of Experimental Biology of the Polish Academy of Sciences, Warsaw, Poland
| | - Jan Rodriguez Parkitna
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
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5
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Falaki A, Cuadra C, Lewis MM, Prado-Rico JM, Huang X, Latash ML. Multi-muscle synergies in preparation for gait initiation in Parkinson's disease. Clin Neurophysiol 2023; 154:12-24. [PMID: 37524005 DOI: 10.1016/j.clinph.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/20/2023] [Accepted: 06/25/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE We investigated changes in indices of muscle synergies prior to gait initiation and the effects of gaze shift in patients with Parkinson's disease (PD). A long-term objective of the study is to develop a method for quantitative assessment of gait-initiation problems in PD. METHODS PD patients without clinical signs of postural instability and two control groups (age-matched and young) performed a gait initiation task in a self-paced manner, with and without a quick prior gaze shift produced by turning the head. Muscle groups with parallel scaling of activation levels (muscle modes) were identified as factors in the muscle activation space. Synergy index stabilizing center of pressure trajectory in the anterior-posterior and medio-lateral directions (indices of stability) was quantified in the muscle mode space. A drop in the synergy index in preparation to gait initiation (anticipatory synergy adjustment, ASA) was quantified. RESULTS Compared to the control groups, PD patients showed significantly smaller synergy indices and ASA for both directions of the center of pressure shift. Both PD and age-matched controls, but not younger controls, showed detrimental effects of the prior gaze shift on the ASA indices. CONCLUSIONS PD patients without clinically significant posture or gait disorders show impaired stability of the center of pressure and its diminished adjustment during gait initiation. SIGNIFICANCE The indices of stability and ASA may be useful to monitor pre-clinical gait disorders, and lower ASA may be relevant to emergence of freezing of gait in PD.
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Affiliation(s)
- Ali Falaki
- Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada
| | - Cristian Cuadra
- Department of Physical Therapy, Emory University, Atlanta, GA, USA; Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, 7591538 Santiago, Chile
| | - Mechelle M Lewis
- Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA; Department of Pharmacology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Janina M Prado-Rico
- Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Xuemei Huang
- Department of Neurology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA; Department of Pharmacology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA; Department of Radiology, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA; Department of Neurosurgery, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA; Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Mark L Latash
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA.
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6
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Ding L. Contributions of the Basal Ganglia to Visual Perceptual Decisions. Annu Rev Vis Sci 2023; 9:385-407. [PMID: 37713277 DOI: 10.1146/annurev-vision-111022-123804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
The basal ganglia (BG) make up a prominent nexus between visual and motor-related brain regions. In contrast to the BG's well-established roles in movement control and value-based decision making, their contributions to the transformation of visual input into an action remain unclear, especially in the context of perceptual decisions based on uncertain visual evidence. This article reviews recent progress in our understanding of the BG's contributions to the formation, evaluation, and adjustment of such decisions. From theoretical and experimental perspectives, the review focuses on four key stations in the BG network, namely, the striatum, pallidum, subthalamic nucleus, and midbrain dopamine neurons, which can have different roles and together support the decision process.
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Affiliation(s)
- Long Ding
- Department of Neuroscience, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
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7
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Marie A, Kinet R, Helbling JC, Darricau M, Alfos S, Di Miceli M, Angelo MF, Foury A, Richard E, Trifilieff P, Mallet NP, Bosch-Bouju C. Impact of dietary vitamin A on striatal function in adult rats. FASEB J 2023; 37:e23037. [PMID: 37392372 DOI: 10.1096/fj.202300133r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/18/2023] [Accepted: 06/05/2023] [Indexed: 07/03/2023]
Abstract
The striatum is a brain structure involved in the control of voluntary movement. Striatum contains high amounts of retinoic acid, the active metabolite of vitamin A, as well as retinoid receptors, RARβ and RXRγ. Previous studies revealed that disruption of retinoid signaling initiated during development is deleterious for striatal physiology and related motor functions. However, the alteration of retinoid signaling, and the importance of vitamin A supply during adulthood on striatal physiology and function has never been established. In the present study, we investigated the impact of vitamin A supply on striatal function. Adult Sprague-Dawley rats were fed with three specific diets, either sub-deficient, sufficient, or enriched in vitamin A (0.4, 5, and 20 international units [IU] of retinol per g of diet, respectively) for 6 months. We first validated that vitamin A sub-deficient diet in adult rats constitutes a physiological model of retinoid signaling reduction in the striatum. We then revealed subtle alterations of fine motor skills in sub-deficient rats using a new behavioral apparatus specifically designed to test forepaw reach-and-grasp skills relying on striatal function. Finally, we showed using qPCR analysis and immunofluorescence that the striatal dopaminergic system per se was not affected by vitamin A sub-deficiency at adult age. Rather, cholinergic synthesis in the striatum and μ-opioid receptor expression in striosomes sub-territories were the most affected by vitamin A sub-deficiency starting at adulthood. Taken together these results revealed that retinoid signaling alteration at adulthood is associated with motor learning deficits together with discrete neurobiological alterations in the striatum.
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Affiliation(s)
- Anaïs Marie
- INRAE, Bordeaux INP, NutriNeuro, UMR 1286, University of Bordeaux, Bordeaux, France
| | - Rémi Kinet
- Institut des Maladies Neurodégénératives, UMR 5293, University of Bordeaux, Bordeaux, France
- CNRS UMR 5293, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | | | - Morgane Darricau
- INRAE, Bordeaux INP, NutriNeuro, UMR 1286, University of Bordeaux, Bordeaux, France
- Institut des Maladies Neurodégénératives, UMR 5293, University of Bordeaux, Bordeaux, France
- CNRS UMR 5293, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Serge Alfos
- INRAE, Bordeaux INP, NutriNeuro, UMR 1286, University of Bordeaux, Bordeaux, France
| | - Mathieu Di Miceli
- Worcester Biomedical Research Group, School of Science and the Environment, University of Worcester, Worcester, UK
| | | | - Aline Foury
- INRAE, Bordeaux INP, NutriNeuro, UMR 1286, University of Bordeaux, Bordeaux, France
| | - Emmanuel Richard
- INSERM, U1035, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Pierre Trifilieff
- INRAE, Bordeaux INP, NutriNeuro, UMR 1286, University of Bordeaux, Bordeaux, France
| | - Nicolas P Mallet
- Institut des Maladies Neurodégénératives, UMR 5293, University of Bordeaux, Bordeaux, France
- CNRS UMR 5293, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
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Béreau M, Van Waes V, Servant M, Magnin E, Tatu L, Anheim M. Apathy in Parkinson's Disease: Clinical Patterns and Neurobiological Basis. Cells 2023; 12:1599. [PMID: 37371068 DOI: 10.3390/cells12121599] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Apathy is commonly defined as a loss of motivation leading to a reduction in goal-directed behaviors. This multidimensional syndrome, which includes cognitive, emotional and behavioral components, is one of the most prevalent neuropsychiatric features of Parkinson's disease (PD). It has been established that the prevalence of apathy increases as PD progresses. However, the pathophysiology and anatomic substrate of this syndrome remain unclear. Apathy seems to be underpinned by impaired anatomical structures that link the prefrontal cortex with the limbic system. It can be encountered in the prodromal stage of the disease and in fluctuating PD patients receiving bilateral chronic subthalamic nucleus stimulation. In these stages, apathy may be considered as a disorder of motivation that embodies amotivational behavioral syndrome, is underpinned by combined dopaminergic and serotonergic denervation and is dopa-responsive. In contrast, in advanced PD patients, apathy may be considered as cognitive apathy that announces cognitive decline and PD dementia, is underpinned by diffuse neurotransmitter system dysfunction and Lewy pathology spreading and is no longer dopa-responsive. In this review, we discuss the clinical patterns of apathy and their treatment, the neurobiological basis of apathy, the potential role of the anatomical structures involved and the pathways in motivational and cognitive apathy.
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Affiliation(s)
- Matthieu Béreau
- Département de Neurologie, CHU de Besançon, 25000 Besançon, France
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Vincent Van Waes
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Mathieu Servant
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Eloi Magnin
- Département de Neurologie, CHU de Besançon, 25000 Besançon, France
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Laurent Tatu
- Département de Neurologie, CHU de Besançon, 25000 Besançon, France
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
- Laboratoire d'Anatomie, Université de Franche-Comté, 25000 Besançon, France
| | - Mathieu Anheim
- Département de Neurologie, CHU de Strasbourg, 67200 Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
- Institut de génétique Et de Biologie Moléculaire Et Cellulaire (IGBMC), INSERM-U964, CNRS-UMR7104, Université de Strasbourg, 67400 Illkirch-Graffenstaden, France
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9
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Gan C, Cao X, Wang L, Sun H, Ji M, Zhang H, Yuan Y, Zhang K. Cholinergic basal forebrain atrophy in Parkinson's disease with freezing of gait. Ann Clin Transl Neurol 2023; 10:814-824. [PMID: 37000969 DOI: 10.1002/acn3.51769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/21/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Mounting research support that cholinergic dysfunction plays a prominent role in freezing of gait (FOG), which commonly occurs in Parkinson's disease (PD). Basal forebrain (BF), especially the cholinergic nuclei 4 (Ch4), provides the primary source of the brain cholinergic input. However, whether the degeneration of BF and its innervated cortex contribute to the pathogenesis of FOG is unknown. OBJECTIVE To explore the role of structural alterations of BF and its innervated cortical brain regions in the pathogenesis of PD patients with freezing. METHODS Magnetic resonance imaging assessments and neurological assessments were performed on 20 PD patients with FOG (PD-FOG), 20 without FOG (PD-NFOG), and 21 healthy participants. Subregion volumes of the BF were compared among groups. Local gyrification index (LGI) was computed to reveal the cortical alternations. Relationships among subregional BF volumes, LGI, and the severity of FOG were evaluated by multiple linear regression. RESULTS Our study discovered that, compared to PD-NFOG, PD-FOG exhibited significant Ch4 atrophy (p = 4.6 × 10-5 ), accompanied by decreased LGI values in the left entorhinal cortex (p = 3.00 × 10-5 ) and parahippocampal gyrus (p = 2.90 × 10-5 ). Based on the regression analysis, Ch4 volume was negatively associated with FOG severity in PD-FOG group (β = -12.224, T = -2.556, p = 0.031). INTERPRETATION Our results imply that Ch4 degeneration and microstructural disorganization of its innervated cortical brain regions may play important roles in PD-FOG.
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10
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Lista S, Vergallo A, Teipel SJ, Lemercier P, Giorgi FS, Gabelle A, Garaci F, Mercuri NB, Babiloni C, Gaire BP, Koronyo Y, Koronyo-Hamaoui M, Hampel H, Nisticò R. Determinants of approved acetylcholinesterase inhibitor response outcomes in Alzheimer's disease: relevance for precision medicine in neurodegenerative diseases. Ageing Res Rev 2023; 84:101819. [PMID: 36526257 DOI: 10.1016/j.arr.2022.101819] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/11/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Acetylcholinesterase inhibitors (ChEI) are the global standard of care for the symptomatic treatment of Alzheimer's disease (AD) and show significant positive effects in neurodegenerative diseases with cognitive and behavioral symptoms. Although experimental and large-scale clinical evidence indicates the potential long-term efficacy of ChEI, primary outcomes are generally heterogeneous across outpatient clinics and regional healthcare systems. Sub-optimal dosing or slow tapering, heterogeneous guidelines about the timing for therapy initiation (prodromal versus dementia stages), healthcare providers' ambivalence to treatment, lack of disease awareness, delayed medical consultation, prescription of ChEI in non-AD cognitive disorders, contribute to the negative outcomes. We present an evidence-based overview of determinants, spanning genetic, molecular, and large-scale networks, involved in the response to ChEI in patients with AD and other neurodegenerative diseases. A comprehensive understanding of cerebral and retinal cholinergic system dysfunctions along with ChEI response predictors in AD is crucial since disease-modifying therapies will frequently be prescribed in combination with ChEI. Therapeutic algorithms tailored to genetic, biological, clinical (endo)phenotypes, and disease stages will help leverage inter-drug synergy and attain optimal combined response outcomes, in line with the precision medicine model.
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Affiliation(s)
- Simone Lista
- Memory Resources and Research Center (CMRR), Neurology Department, Gui de Chauliac University Hospital, Montpellier, France; School of Pharmacy, University of Rome "Tor Vergata", Rome, Italy.
| | - Andrea Vergallo
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Stefan J Teipel
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medicine Rostock, Rostock, Germany
| | - Pablo Lemercier
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Filippo Sean Giorgi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Audrey Gabelle
- Memory Resources and Research Center (CMRR), Neurology Department, Gui de Chauliac University Hospital, Montpellier, France
| | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy; Casa di Cura "San Raffaele Cassino", Cassino, Italy
| | - Nicola B Mercuri
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; IRCCS Santa Lucia Foundation, Rome, Italy
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "Erspamer", Sapienza University of Rome, Rome, Italy; Hospital San Raffaele Cassino, Cassino, Italy
| | - Bhakta Prasad Gaire
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yosef Koronyo
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Biomedical Sciences, Division of Applied Cell Biology and Physiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Harald Hampel
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Robert Nisticò
- School of Pharmacy, University of Rome "Tor Vergata", Rome, Italy; Laboratory of Pharmacology of Synaptic Plasticity, EBRI Rita Levi-Montalcini Foundation, Rome, Italy.
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11
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Bohnen NI, Roytman S, Kanel P, Müller MLTM, Scott PJH, Frey KA, Albin RL, Koeppe RA. Progression of regional cortical cholinergic denervation in Parkinson's disease. Brain Commun 2022; 4:fcac320. [PMID: 36569603 PMCID: PMC9772878 DOI: 10.1093/braincomms/fcac320] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/13/2022] [Accepted: 12/01/2022] [Indexed: 12/03/2022] Open
Abstract
Cortical cholinergic deficits contribute to cognitive decline and other deficits in Parkinson's disease. Cross-sectional imaging studies suggest a stereotyped pattern of posterior-to-anterior cortical cholinergic denervation accompanying disease progression in Parkinson's disease. We used serial acetylcholinesterase PET ligand imaging to characterize the trajectory of regional cholinergic synapse deficits in Parkinson's disease, testing the hypothesis of posterior-to-anterior progression of cortical cholinergic deficits. The 16 Parkinson's disease subjects (4 females/12 males; mean age: 64.4 ± 6.7 years; disease duration: 5.5 ± 4.2 years; Hoehn & Yahr stage: 2.3 ± 0.6 at entry) completed serial 11C-methyl-4-piperidinyl propionate acetylcholinesterase PET scans over a 4-8 year period (median 5 years). Three-dimensional stereotactic cortical surface projections and volume-of-interest analyses were performed. Cholinergic synapse integrity was assessed by the magnitude, k 3, of acetylcholinesterase hydrolysis of 11C-methyl-4-piperidinyl propionate. Based on normative data, we generated Z-score maps for both the k 3 and the k 1 parameters, the latter as a proxy for regional cerebral blood flow. Compared with control subjects, baseline scans showed predominantly posterior cortical k 3 deficits in Parkinson's disease subjects. Interval change analyses showed evidence of posterior-to-anterior progression of cholinergic cortical deficits in the posterior cortices. In frontal cortices, an opposite gradient of anterior-to-posterior progression of cholinergic deficits was found. The topography of k 3 changes exhibited regionally specific disconnection from k 1 changes. Interval-change analysis based on k 3/k 1 ratio images (k 3 adjustment for regional cerebral blood flow changes) showed interval reductions (up to 20%) in ventral frontal, anterior cingulate and Brodmann area 6 cortices. In contrast, interval k 3 reductions in the posterior cortices, especially Brodmann areas 17-19, were largely proportional to k 1 changes. Our results partially support the hypothesis of progressive posterior-to-cortical cholinergic denervation in Parkinson's disease. This pattern appears characteristic of posterior cortices. In frontal cortices, an opposite pattern of anterior-to-posterior progression of cholinergic deficits was found. The progressive decline of posterior cortical acetylcholinesterase activity was largely proportional to declining regional cerebral blood flow, suggesting that posterior cortical cholinergic synapse deficits are part of a generalized loss of synapses. The disproportionate decline in regional frontal cortical acetylcholinesterase activity relative to regional cerebral blood flow suggests preferential loss or dysregulation of cholinergic synapses in these regions. Our observations suggest that cortical cholinergic synapse vulnerability in Parkinson's disease is mediated by both diffuse processes affecting cortical synapses and processes specific to subpopulations of cortical cholinergic afferents.
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Affiliation(s)
- Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stiven Roytman
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
| | - Martijn L T M Müller
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson Consortium, Critical Path Institute, Tucson, AZ 85718, USA
| | - Peter J H Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kirk A Frey
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
| | - Robert A Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
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