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Wang X, Li Y, Li B, Shang H, Yang J. Gray matter alterations in Huntington's disease: A meta-analysis of VBM neuroimaging studies. J Neurosci Res 2024; 102:e25366. [PMID: 38953592 DOI: 10.1002/jnr.25366] [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: 01/21/2024] [Revised: 05/16/2024] [Accepted: 06/16/2024] [Indexed: 07/04/2024]
Abstract
Increasing neuroimaging studies have attempted to identify biomarkers of Huntington's disease (HD) progression. Here, we conducted voxel-based meta-analyses of voxel-based morphometry (VBM) studies on HD to investigate the evolution of gray matter volume (GMV) alterations and explore the effects of genetic and clinical features on GMV changes. A systematic review was performed to identify the relevant studies. Meta-analyses of whole-brain VBM studies were performed to assess the regional GMV changes in all HD mutation carriers, in presymptomatic HD (pre-HD), and in symptomatic HD (sym-HD). A quantitative comparison was performed between pre-HD and sym-HD. Meta-regression analyses were used to explore the effects of genetic and clinical features on GMV changes. Twenty-eight studies were included, comparing a total of 1811 HD mutation carriers [including 1150 pre-HD and 560 sym-HD] and 969 healthy controls (HCs). Pre-HD showed decreased GMV in the bilateral caudate nuclei, putamen, insula, anterior cingulate/paracingulate gyri, middle temporal gyri, and left dorsolateral superior frontal gyrus compared with HCs. Compared with pre-HD, GMV decrease in sym-HD extended to the bilateral median cingulate/paracingulate gyri, Rolandic operculum and middle occipital gyri, left amygdala, and superior temporal gyrus. Meta-regression analyses found that age, mean lengths of CAG repeats, and disease burden were negatively associated with GMV atrophy of the bilateral caudate and right insula in all HD mutation carriers. This meta-analysis revealed the pattern of GMV changes from pre-HD to sym-HD, prompting the understanding of HD progression. The pattern of GMV changes may be biomarkers for disease progression in HD.
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Affiliation(s)
- Xi Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuming Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Boyi Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Bjerkan J, Kobal J, Lancaster G, Šešok S, Meglič B, McClintock PVE, Budohoski KP, Kirkpatrick PJ, Stefanovska A. The phase coherence of the neurovascular unit is reduced in Huntington's disease. Brain Commun 2024; 6:fcae166. [PMID: 38938620 PMCID: PMC11210076 DOI: 10.1093/braincomms/fcae166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/07/2024] [Accepted: 05/09/2024] [Indexed: 06/29/2024] Open
Abstract
Huntington's disease is a neurodegenerative disorder in which neuronal death leads to chorea and cognitive decline. Individuals with ≥40 cytosine-adenine-guanine repeats on the interesting transcript 15 gene develop Huntington's disease due to a mutated huntingtin protein. While the associated structural and molecular changes are well characterized, the alterations in neurovascular function that lead to the symptoms are not yet fully understood. Recently, the neurovascular unit has gained attention as a key player in neurodegenerative diseases. The mutant huntingtin protein is known to be present in the major parts of the neurovascular unit in individuals with Huntington's disease. However, a non-invasive assessment of neurovascular unit function in Huntington's disease has not yet been performed. Here, we investigate neurovascular interactions in presymptomatic (N = 13) and symptomatic (N = 15) Huntington's disease participants compared to healthy controls (N = 36). To assess the dynamics of oxygen transport to the brain, functional near-infrared spectroscopy, ECG and respiration effort were recorded. Simultaneously, neuronal activity was assessed using EEG. The resultant time series were analysed using methods for discerning time-resolved multiscale dynamics, such as wavelet transform power and wavelet phase coherence. Neurovascular phase coherence in the interval around 0.1 Hz is significantly reduced in both Huntington's disease groups. The presymptomatic Huntington's disease group has a lower power of oxygenation oscillations compared to controls. The spatial coherence of the oxygenation oscillations is lower in the symptomatic Huntington's disease group compared to the controls. The EEG phase coherence, especially in the α band, is reduced in both Huntington's disease groups and, to a significantly greater extent, in the symptomatic group. Our results show a reduced efficiency of the neurovascular unit in Huntington's disease both in the presymptomatic and symptomatic stages of the disease. The vasculature is already significantly impaired in the presymptomatic stage of the disease, resulting in reduced cerebral blood flow control. The results indicate vascular remodelling, which is most likely a compensatory mechanism. In contrast, the declines in α and γ coherence indicate a gradual deterioration of neuronal activity. The results raise the question of whether functional changes in the vasculature precede the functional changes in neuronal activity, which requires further investigation. The observation of altered dynamics paves the way for a simple method to monitor the progression of Huntington's disease non-invasively and evaluate the efficacy of treatments.
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Affiliation(s)
- Juliane Bjerkan
- Department of Physics, Lancaster University, Lancaster LA1 4YB, UK
| | - Jan Kobal
- Department of Neurology, University Medical Centre, 1525 Ljubljana, Slovenia
| | - Gemma Lancaster
- Department of Physics, Lancaster University, Lancaster LA1 4YB, UK
| | - Sanja Šešok
- Department of Neurology, University Medical Centre, 1525 Ljubljana, Slovenia
| | - Bernard Meglič
- Department of Neurology, University Medical Centre, 1525 Ljubljana, Slovenia
| | | | - Karol P Budohoski
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Peter J Kirkpatrick
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
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Mehanna R, Jankovic J. Systemic Symptoms in Huntington's Disease: A Comprehensive Review. Mov Disord Clin Pract 2024; 11:453-464. [PMID: 38529740 PMCID: PMC11078495 DOI: 10.1002/mdc3.14029] [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: 12/02/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Although Huntington's disease (HD) is usually thought of as a triad of motor, cognitive, and psychiatric symptoms, there is growing appreciation of HD as a systemic illness affecting the entire body. OBJECTIVES This review aims to draw attention to these systemic non-motor symptoms in HD. METHODS We identified relevant studies published in English by searching MEDLINE (from 1966 to September 2023), using the following subject headings: Huntington disease, autonomic, systemic, cardiovascular, respiratory, gastrointestinal, urinary, sexual and cutaneous, and additional specific symptoms. RESULTS Data from 123 articles were critically reviewed with focus on systemic features associated with HD, such as cardiovascular, respiratory, gastrointestinal, urinary, sexual and sweating. CONCLUSION This systematic review draws attention to a variety of systemic and autonomic co-morbidities in patients with HD. Not all of them correlate with the severity of the primary HD symptoms or CAG repeats. More research is needed to better understand the pathophysiology and treatment of systemic and autonomic dysfunction in HD.
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Affiliation(s)
- Raja Mehanna
- Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Trujillo-Rangel WÁ, Acuña-Vaca S, Padilla-Ponce DJ, García-Mercado FG, Torres-Mendoza BM, Pacheco-Moises FP, Escoto-Delgadillo M, García-Benavides L, Delgado-Lara DLC. Modulation of the Circadian Rhythm and Oxidative Stress as Molecular Targets to Improve Vascular Dementia: A Pharmacological Perspective. Int J Mol Sci 2024; 25:4401. [PMID: 38673986 PMCID: PMC11050388 DOI: 10.3390/ijms25084401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
The circadian rhythms generated by the master biological clock located in the brain's hypothalamus influence central physiological processes. At the molecular level, a core set of clock genes interact to form transcription-translation feedback loops that provide the molecular basis of the circadian rhythm. In animal models of disease, a desynchronization of clock genes in peripheral tissues with the central master clock has been detected. Interestingly, patients with vascular dementia have sleep disorders and irregular sleep patterns. These alterations in circadian rhythms impact hormonal levels, cardiovascular health (including blood pressure regulation and blood vessel function), and the pattern of expression and activity of antioxidant enzymes. Additionally, oxidative stress in vascular dementia can arise from ischemia-reperfusion injury, amyloid-beta production, the abnormal phosphorylation of tau protein, and alterations in neurotransmitters, among others. Several signaling pathways are involved in the pathogenesis of vascular dementia. While the precise mechanisms linking circadian rhythms and vascular dementia are still being studied, there is evidence to suggest that maintaining healthy sleep patterns and supporting proper circadian rhythm function may be important for reducing the risk of vascular dementia. Here, we reviewed the main mechanisms of action of molecular targets related to the circadian cycle and oxidative stress in vascular dementia.
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Affiliation(s)
- Walter Ángel Trujillo-Rangel
- Departamento de Ciencias Biomédicas, Centro Universitario de Tonalá, Universidad de Guadalajara, Av. Nuevo Periférico No. 555, Ejido San José Tateposco, Tonalá 45425, Jalisco, Mexico; (W.Á.T.-R.); (D.J.P.-P.); (F.G.G.-M.); (L.G.-B.)
- Departamento de Formación Universitaria Ciencias de la Salud, Universidad Autónoma de Guadalajara, Av. Patria 1201, Lomas del Valle, Zapopan 45129, Jalisco, Mexico;
| | - Sofía Acuña-Vaca
- Departamento de Formación Universitaria Ciencias de la Salud, Universidad Autónoma de Guadalajara, Av. Patria 1201, Lomas del Valle, Zapopan 45129, Jalisco, Mexico;
| | - Danna Jocelyn Padilla-Ponce
- Departamento de Ciencias Biomédicas, Centro Universitario de Tonalá, Universidad de Guadalajara, Av. Nuevo Periférico No. 555, Ejido San José Tateposco, Tonalá 45425, Jalisco, Mexico; (W.Á.T.-R.); (D.J.P.-P.); (F.G.G.-M.); (L.G.-B.)
| | - Florencia Guillermina García-Mercado
- Departamento de Ciencias Biomédicas, Centro Universitario de Tonalá, Universidad de Guadalajara, Av. Nuevo Periférico No. 555, Ejido San José Tateposco, Tonalá 45425, Jalisco, Mexico; (W.Á.T.-R.); (D.J.P.-P.); (F.G.G.-M.); (L.G.-B.)
| | - Blanca Miriam Torres-Mendoza
- División de Neurociencias, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Sierra Mojada 800, Colonia Independencia, Guadalajara 44340, Jalisco, Mexico; (B.M.T.-M.); (M.E.-D.)
- Departamento de Disciplinas Filosófico, Metodológicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Colonia Independencia, Guadalajara 44340, Jalisco, Mexico
| | - Fermín P. Pacheco-Moises
- Departamento de Química, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara, Blvd. Marcelino García Barragán No. 1421, Guadalajara 44430, Jalisco, Mexico;
| | - Martha Escoto-Delgadillo
- División de Neurociencias, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Sierra Mojada 800, Colonia Independencia, Guadalajara 44340, Jalisco, Mexico; (B.M.T.-M.); (M.E.-D.)
- Centro Universitario de Ciencias Biológicas y Agropecuarias, Universidad de Guadalajara, Camino Ramón Padilla Sánchez No. 2100, Zapopan 45200, Jalisco, Mexico
| | - Leonel García-Benavides
- Departamento de Ciencias Biomédicas, Centro Universitario de Tonalá, Universidad de Guadalajara, Av. Nuevo Periférico No. 555, Ejido San José Tateposco, Tonalá 45425, Jalisco, Mexico; (W.Á.T.-R.); (D.J.P.-P.); (F.G.G.-M.); (L.G.-B.)
| | - Daniela L. C. Delgado-Lara
- Departamento de Formación Universitaria Ciencias de la Salud, Universidad Autónoma de Guadalajara, Av. Patria 1201, Lomas del Valle, Zapopan 45129, Jalisco, Mexico;
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Ekwudo MN, Gubert C, Hannan AJ. The microbiota-gut-brain axis in Huntington's disease: pathogenic mechanisms and therapeutic targets. FEBS J 2024. [PMID: 38426291 DOI: 10.1111/febs.17102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/08/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
Huntington's disease (HD) is a currently incurable neurogenerative disorder and is typically characterized by progressive movement disorder (including chorea), cognitive deficits (culminating in dementia), psychiatric abnormalities (the most common of which is depression), and peripheral symptoms (including gastrointestinal dysfunction). There are currently no approved disease-modifying therapies available for HD, with death usually occurring approximately 10-25 years after onset, but some therapies hold promising potential. HD subjects are often burdened by chronic diarrhea, constipation, esophageal and gastric inflammation, and a susceptibility to diabetes. Our understanding of the microbiota-gut-brain axis in HD is in its infancy and growing evidence from preclinical and clinical studies suggests a role of gut microbial population imbalance (gut dysbiosis) in HD pathophysiology. The gut and the brain can communicate through the enteric nervous system, immune system, vagus nerve, and microbiota-derived-metabolites including short-chain fatty acids, bile acids, and branched-chain amino acids. This review summarizes supporting evidence demonstrating the alterations in bacterial and fungal composition that may be associated with HD. We focus on mechanisms through which gut dysbiosis may compromise brain and gut health, thus triggering neuroinflammatory responses, and further highlight outcomes of attempts to modulate the gut microbiota as promising therapeutic strategies for HD. Ultimately, we discuss the dearth of data and the need for more longitudinal and translational studies in this nascent field. We suggest future directions to improve our understanding of the association between gut microbes and the pathogenesis of HD, and other 'brain and body disorders'.
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Affiliation(s)
- Millicent N Ekwudo
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Carolina Gubert
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Anthony J Hannan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
- Department of Anatomy and Physiology, University of Melbourne, Parkville, Australia
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Griffis CG, Mistry J, Islam K, Cutler T, Colwell CS, Garfinkel A. Circadian and ultradian rhythms in normal mice and in a mouse model of Huntington's disease. Chronobiol Int 2022; 39:513-524. [PMID: 34983274 PMCID: PMC11225972 DOI: 10.1080/07420528.2021.2014516] [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: 08/02/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/03/2022]
Abstract
Circadian rhythms in core body temperature (CBT) have been widely studied, but fewer studies have explored higher-frequency (ultradian) rhythms in detail. We analyzed CBT recordings from young and middle-aged wild-type mice as well as from the Q175 model of Huntington's disease (HD), at sufficient temporal resolution to address the question of ultradian rhythms. We used model selection methods to show that the overall circadian pattern was better fit by a square wave than a sine wave. Then, using Fourier analysis of the CBT rhythms, we identified the spectral signature of an 8-hour oscillation that occurs in the night but not the day, an observation that can be confirmed by direct inspection of the rhythms. This diurnal amplitude modulation of the 8-hour rhythm was lost with aging as well as in the HD model. Thus, the impact of aging and disease is seen here in the loss of the ability to separate rhythms into a daytime phase and a nighttime phase. These findings raise the possibility that ultradian rhythms in CBT may be a useful biomarker for the pathology within the central nervous system.
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Affiliation(s)
- Christopher G. Griffis
- Department of Ophthalmology, David Geffen School of Medicine (DGSOM), University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Janki Mistry
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Integrative Biology and Physiology, UCLA, Los Angeles, California, USA
| | - Kendall Islam
- Department of Integrative Biology and Physiology, UCLA, Los Angeles, California, USA
- Division of General Internal Medicine, University of California, San Francisco, California, USA
| | - Tamara Cutler
- Department of Psychiatry and Biobehavioral Sciences, DGSOM at UCLA, Los Angeles, California, USA
| | - Christopher S. Colwell
- Department of Psychiatry and Biobehavioral Sciences, DGSOM at UCLA, Los Angeles, California, USA
| | - Alan Garfinkel
- Department of Integrative Biology and Physiology, UCLA, Los Angeles, California, USA
- Department of Medicine (Cardiology), DGSOM at UCLA, Los Angeles, California, USA
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Schultz JL, Heinzerling AE, Brinker AN, Harshman LA, Magnotta VA, Kamholz JA, Boes AD, Nopoulos PC. Autonomic changes in Huntington's disease correlate with altered central autonomic network connectivity. Brain Commun 2022; 4:fcac253. [PMID: 36324870 PMCID: PMC9617256 DOI: 10.1093/braincomms/fcac253] [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: 02/28/2022] [Revised: 06/20/2022] [Accepted: 10/06/2022] [Indexed: 01/24/2023] Open
Abstract
Autonomic dysfunction has been described in patients with Huntington's disease, but it is unclear if these changes in autonomic tone are related to the central autonomic network. We performed a pilot study to investigate the relationship between the integrity of the central autonomic network and peripheral manifestiations of autonomic dysfunction in premanifest Huntington's disease. We recruited male participants with pre-motor-manifest Huntington's disease and a comparison group consisting of healthy, male participants of approximately the same age. As this was a pilot study, only males were included to reduce confounding. Participants underwent a resting-state functional magnetic resonance imaging study to quantify functional connectivity within the central autonomic network, as well as a resting 3-lead ECG to measure heart rate variability with a particular focus on the parasympathetic time-domain measures of root mean square of successive differences between normal heartbeats. The pre-motor-manifest Huntington's disease participants had significantly decreased root mean square of successive differences between normal heartbeats values compared with the healthy comparison group. The pre-motor-manifest Huntington's disease group had significantly lower functional connectivity within the central autonomic network, which was positively correlated with root mean square of successive differences between normal heartbeats. Patients with pre-motor-manifest Huntington's disease have reduced functional connectivity within the central autonomic network, which is significantly associated with observed changes in autonomic function.
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Affiliation(s)
- Jordan L Schultz
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, USA.,University of Iowa Carver College of Medicine, Department of Neurology, Iowa City, IA, USA.,University of Iowa College of Pharmacy, Department of Pharmacy Practice and Sciences, Iowa City, IA, USA
| | - Amanda E Heinzerling
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, USA
| | - Alivia N Brinker
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, USA
| | - Lyndsay A Harshman
- University of Iowa Carver College of Medicine, Department of Pediatrics, Iowa City, IA, USA
| | - Vincent A Magnotta
- University of Iowa College of Medicine, Department of Radiology, Iowa City, IA, USA
| | - John A Kamholz
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, USA.,University of Iowa Carver College of Medicine, Department of Neurology, Iowa City, IA, USA
| | - Aaron D Boes
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, USA.,University of Iowa Carver College of Medicine, Department of Neurology, Iowa City, IA, USA.,University of Iowa Carver College of Medicine, Department of Pediatrics, Iowa City, IA, USA
| | - Peg C Nopoulos
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, USA.,University of Iowa Carver College of Medicine, Department of Neurology, Iowa City, IA, USA.,University of Iowa Carver College of Medicine, Department of Pediatrics, Iowa City, IA, USA
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Marotta J, Piano C, Brunetti V, Genovese D, Bentivoglio AR, Calabresi P, Cortelli P, Della Marca G. Heart Rate Variability during wake and sleep in Huntington's Disease patients. An observational, cross-sectional, cohort study. NEURODEGENER DIS 2021; 21:79-86. [PMID: 34749365 DOI: 10.1159/000520754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Autonomic dysfunction has been reported as one of non-motor manifestations of both pre-symptomatic and manifest Huntington's Disease (HD). The aim of our study was to evaluate heart rate variability (HRV) during wake and sleep in a cohort of patients with manifest HD. Methods Thirty consecutive patients with manifest HD were enrolled, 14 men and 16 women, mean age 57.3±12.2 years. All patients underwent full-night attended video-polysomnography. HRV was analyzed during wake, NREM and REM sleep, in time and frequency domain. Results were compared with a control group of healthy volunteers matched for age and sex. Results During wake HD patients presented significantly higher mean heart rate than controls (72.4±9.6 vs 58.1±7.3 bpm; p<0.001). During NREM sleep, HD patients showed higher mean heart rate (65.6±11.1 vs 48.8±4.6 bpm; p<0.001) and greater Low Frequency (LF) component of HRV (52.9±22.6 vs 35.5±17.3 n.u.; p=0.004). During REM sleep, we observed lower standard deviation of the R-R interval (SDNN) in HD subjects (3.4±2.2 vs 3.7±1.3 ms; p=0.015). Conclusion Our results showed that HD patients have higher heart rate than controls, during wake and NREM, but not during REM sleep. Among HRV variability parameters, the most relevant difference regarded the LF component, which reflects, at least partially, the ortho-sympathetic output. Our results confirm the involvement of autonomic nervous system in HD and demonstrate that it is evident during both wake and sleep.
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Affiliation(s)
- Jessica Marotta
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carla Piano
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valerio Brunetti
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Danilo Genovese
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Rita Bentivoglio
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Calabresi
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giacomo Della Marca
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract
Neurodegenerative diseases encompass a large group of conditions that are clinically and pathologically diverse yet are linked by a shared pathology of misfolded proteins. The accumulation of insoluble aggregates is accompanied by a progressive loss of vulnerable neurons. For some patients, the symptoms are motor focused (ataxias), while others experience cognitive and psychiatric symptoms (dementias). Among the shared symptoms of neurodegenerative diseases is a disruption of the sleep/wake cycle that occurs early in the trajectory of the disease and may be a risk factor for disease development. In many cases, the disruption in the timing of sleep and other rhythmic physiological markers immediately raises the possibility of neurodegeneration-driven disruption of the circadian timing system. The aim of this Review is to summarize the evidence supporting the hypothesis that circadian disruption is a core symptom within neurodegenerative diseases, including Alzheimer's disease, Huntington's disease, and Parkinson's disease, and to discuss the latest progress in this field. The Review discusses evidence that neurodegenerative processes may disrupt the structure and function of the circadian system and describes circadian-based interventions as well as timed drug treatments that may improve a wide range of symptoms associated with neurodegenerative disorders. It also identifies key gaps in our knowledge.
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