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Timm EC, Purcell NL, Ouyang B, Berry-Kravis E, Hall DA, O’Keefe JA. Potential Prodromal Digital Postural Sway Markers for Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS) Detected via Dual-Tasking and Sensory Manipulation. SENSORS (BASEL, SWITZERLAND) 2024; 24:2586. [PMID: 38676203 PMCID: PMC11054629 DOI: 10.3390/s24082586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/27/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
FXTAS is a neurodegenerative disorder occurring in some Fragile X Messenger Ribonucleoprotein 1 (FMR1) gene premutation carriers (PMCs) and is characterized by cerebellar ataxia, tremor, and cognitive deficits that negatively impact balance and gait and increase fall risk. Dual-tasking (DT) cognitive-motor paradigms and challenging balance conditions may have the capacity to reveal markers of FXTAS onset. Our objectives were to determine the impact of dual-tasking and sensory and stance manipulation on balance in FXTAS and potentially detect subtle postural sway deficits in FMR1 PMCs who are asymptomatic for signs of FXTAS on clinical exam. Participants with FXTAS, PMCs without FXTAS, and controls underwent balance testing using an inertial sensor system. Stance, vision, surface stability, and cognitive demand were manipulated in 30 s trials. FXTAS participants had significantly greater total sway area, jerk, and RMS sway than controls under almost all balance conditions but were most impaired in those requiring vestibular control. PMCs without FXTAS had significantly greater RMS sway compared with controls in the feet apart, firm, single task conditions both with eyes open and closed (EC) and the feet together, firm, EC, DT condition. Postural sway deficits in the RMS postural sway variability domain in asymptomatic PMCs might represent prodromal signs of FXTAS. This information may be useful in providing sensitive biomarkers of FXTAS onset and as quantitative balance measures in future interventional trials and longitudinal natural history studies.
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Affiliation(s)
- Emily C. Timm
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
| | - Nicollette L. Purcell
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
| | - Elizabeth Berry-Kravis
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Deborah A. Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
| | - Joan Ann O’Keefe
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
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Winser SJ, Chan AYY, Whitney SL, Chen CH, Pang MYC. Effectiveness and cost of integrated cognitive and balance training for balance and falls in cerebellar ataxia: a blinded two-arm parallel group RCT. Front Neurol 2024; 14:1267099. [PMID: 38313407 PMCID: PMC10834731 DOI: 10.3389/fneur.2023.1267099] [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: 07/26/2023] [Accepted: 12/27/2023] [Indexed: 02/06/2024] Open
Abstract
Background In patients with cerebellar ataxia (CA), dual-tasking deteriorates the performance of one or both tasks. Objective Evaluate the effects of 4 weeks of cognitive-coupled intensive balance training (CIBT) on dual-task cost, dynamic balance, disease severity, number of falls, quality of life, cognition and cost among patients with CA. Methods This RCT compared CIBT (Group 1) to single-task training (Group 2) among 32 patients with CA. The intervention included either dual-task (CIBT) or single-task training for 4 weeks followed by 6 months of unsupervised home exercises. Dual-task timed up-and-go test (D-TUG) assessed dual-task cost of the physical and cognitive tasks. Assessment time points included baseline 1 (Week 0:T1), baseline 2 (Week 6:T2), post-intervention (Week 10:T3), and follow-up (Week 34:T4). Results Compared to single-task training CIBT improved the dual-task cost of physical task [MD -8.36 95% CI (-14.47 to -2.36, p < 0.01), dual-tasking ability [-6.93 (-13.16 to -0.70); p = 0.03] assessed using D-TUG, balance assessed using the scale for the assessment and rating of ataxia (SARAbal) [-2.03 (-4.04 to -0.19); p = 0.04], visual scores of the SOT (SOT-VIS) [-18.53 (-25.81 to -11.24, p ≤ 0.01] and maximal excursion [13.84 (4.65 to 23.03; p ≤ 0.01] of the Limits of Stability (LOS) in the forward direction and reaction time in both forward [-1.11 (-1.42 to -0.78); p < 0.01] and right [-0.18 (0.05 to 0.31); p < 0.01] directions following 4 weeks of training. CIBT did not have any additional benefits in reducing the number of falls, or improving disease severity, quality of life and cognition. The mean cost of intervention and healthcare costs for 7 months was HKD 33,380 for CIBT group and HKD 38,571 for single-task training group. Conclusion We found some evidence to support the use of CIBT for improving the dual-tasking ability, dual-task cost of physical task and dynamic balance in CA. Future large fully-powered studies are needed to confirm this claim. Clinical trial registration https://clinicaltrials.gov/study/NCT04648501, identifier [Ref: NCT04648501].
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Affiliation(s)
- Stanley J. Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Anne Y. Y. Chan
- Division of Neurology, Prince of Wales Hospital and Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Susan L. Whitney
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cynthia H. Chen
- Saw Swee Hock School of Public Health (Primary), National University of Singapore, Singapore, Singapore
| | - Marco Y. C. Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Fielding-Gebhardt H, Kelly SE, Unruh KE, Schmitt LM, Pulver SL, Khemani P, Mosconi MW. Sensorimotor and inhibitory control in aging FMR1 premutation carriers. Front Hum Neurosci 2023; 17:1271158. [PMID: 38034068 PMCID: PMC10687573 DOI: 10.3389/fnhum.2023.1271158] [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: 08/01/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023] Open
Abstract
Aging FMR1 premutation carriers are at risk of developing neurodegenerative disorders, including fragile X-associated tremor/ataxia syndrome (FXTAS), and there is a need to identify biomarkers that can aid in identification and treatment of these disorders. While FXTAS is more common in males than females, females can develop the disease, and some evidence suggests that patterns of impairment may differ across sexes. Few studies include females with symptoms of FXTAS, and as a result, little information is available on key phenotypes for tracking disease risk and progression in female premutation carriers. Our aim was to examine quantitative motor and cognitive traits in aging premutation carriers. We administered oculomotor tests of visually guided/reactive saccades (motor) and antisaccades (cognitive control) in 22 premutation carriers (73% female) and 32 age- and sex-matched healthy controls. Neither reactive saccade latency nor accuracy differed between groups. FMR1 premutation carriers showed increased antisaccade latencies relative to controls, both when considering males and females together and when analyzing females separately. Reduced saccade accuracy and increased antisaccade latency each were associated with more severe clinically rated neuromotor impairments. Findings indicate that together male and female premutation carriers show a reduced ability to rapidly exert volitional control over prepotent responses and that quantitative differences in oculomotor behavior, including control of visually guided and antisaccades, may track with FXTAS - related degeneration in male and female premutation carriers.
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Affiliation(s)
| | | | - Kathryn E. Unruh
- Life Span Institute, University of Kansas, Lawrence, KS, United States
- Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, United States
| | - Lauren M. Schmitt
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Stormi L. Pulver
- Division of Autism and Related Disorders, Emory University School of Medicine, Atlanta, GA, United States
| | - Pravin Khemani
- Movement Disorders Program, Swedish Neuroscience Institute, Seattle, WA, United States
| | - Matthew W. Mosconi
- Life Span Institute, University of Kansas, Lawrence, KS, United States
- Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, United States
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, United States
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Friedman L, Lauber M, Behroozmand R, Fogerty D, Kunecki D, Berry-Kravis E, Klusek J. Atypical vocal quality in women with the FMR1 premutation: an indicator of impaired sensorimotor control. Exp Brain Res 2023; 241:1975-1987. [PMID: 37347418 PMCID: PMC10863608 DOI: 10.1007/s00221-023-06653-2] [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: 02/07/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
Women with the FMR1 premutation are susceptible to motor involvement related to atypical cerebellar function, including risk for developing fragile X tremor ataxia syndrome. Vocal quality analyses are sensitive to subtle differences in motor skills but have not yet been applied to the FMR1 premutation. This study examined whether women with the FMR1 premutation demonstrate differences in vocal quality, and whether such differences relate to FMR1 genetic, executive, motor, or health features of the FMR1 premutation. Participants included 35 women with the FMR1 premutation and 45 age-matched women without the FMR1 premutation who served as a comparison group. Three sustained /a/ vowels were analyzed for pitch (mean F0), variability of pitch (standard deviation of F0), and overall vocal quality (jitter, shimmer, and harmonics-to-noise ratio). Executive, motor, and health indices were obtained from direct and self-report measures and genetic samples were analyzed for FMR1 CGG repeat length and activation ratio. Women with the FMR1 premutation had a lower pitch, larger pitch variability, and poorer vocal quality than the comparison group. Working memory was related to harmonics-to-noise ratio and shimmer in women with the FMR1 premutation. Vocal quality abnormalities differentiated women with the FMR1 premutation from the comparison group and were evident even in the absence of other clinically evident motor deficits. This study supports vocal quality analyses as a tool that may prove useful in the detection of early signs of motor involvement in this population.
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Affiliation(s)
- Laura Friedman
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, USA
| | - Meagan Lauber
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, USA
| | - Roozbeh Behroozmand
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, USA
| | - Daniel Fogerty
- Department of Speech and Hearing Science, University of Illinois Urbana-Champaign, Champaign, USA
| | - Dariusz Kunecki
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
| | | | - Jessica Klusek
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, USA.
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Hocking DR, Loesch DZ, Stimpson P, Tassone F, Atkinson A, Storey E. Relationships of Motor Changes with Cognitive and Neuropsychiatric Features in FMR1 Male Carriers Affected with Fragile X-Associated Tremor/Ataxia Syndrome. Brain Sci 2022; 12:brainsci12111549. [PMID: 36421873 PMCID: PMC9688438 DOI: 10.3390/brainsci12111549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
The premutation expansion of the Fragile X Messenger Ribonucleoprotein 1 (FMR1) gene on the X chromosome has been linked to a range of clinical and subclinical features. Nearly half of men with FMR1 premutation develop a neurodegenerative disorder; Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS). In this syndrome, cognitive executive decline and psychiatric changes may co-occur with major motor features, and in this study, we explored the interrelationships between these three domains in a sample of adult males affected with FXTAS. A sample of 23 adult males aged between 48 and 80 years (mean = 62.3; SD = 8.8), carrying premutation expansions between 45 and 118 CGG repeats, and affected with FXTAS, were included in this study. We employed a battery of cognitive assessments, two standard motor rating scales, and two self-reported measures of psychiatric symptoms. When controlling for age and/or educational level, where appropriate, there were highly significant correlations between motor rating score for ICARS gait domain, and the scores representing global cognitive decline (ACE-III), processing speed (SDMT), immediate memory (Digit Span), and depression and anxiety scores derived from both SCL90 and DASS instruments. Remarkably, close relationships of UPDRS scores, representing the contribution of Parkinsonism to FXTAS phenotypes, were exclusive to psychiatric scores. Highly significant relationships between CGG repeat size and most scores for three phenotypic domains suggest a close tracking with genetic liability. These findings of relationships between a constellation of phenotypic domains in male PM carriers with FXTAS are reminiscent of other conditions associated with disruption to cerebro-cerebellar circuits.
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Affiliation(s)
- Darren R. Hocking
- Developmental Neuromotor & Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
- Correspondence:
| | - Danuta Z. Loesch
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
| | - Paige Stimpson
- Psychology Department, Monash Health, Clayton, VIC 3068, Australia
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, M.I.N.D. Institute, School of Medicine, University of California Davis Medical Center, University of California, Davis, Davis, CA 95616, USA
| | - Anna Atkinson
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
| | - Elsdon Storey
- Department of Medicine (Neuroscience), Alfred Hospital Campus, Monash University, Melbourne, VIC 3068, Australia
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Klusek J, Newman-Norlund R, Fairchild AJ, Newman-Norlund S, Sayers S, Stewart JC, Berry-Kravis E, Fridriksson J. Low normal FMR1 genotype in older adult women: Psychological well-being and motor function. Arch Gerontol Geriatr 2022; 103:104789. [PMID: 35981426 PMCID: PMC9464716 DOI: 10.1016/j.archger.2022.104789] [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: 04/06/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/28/2022]
Abstract
The FMR1 gene plays a key role in adult neurogenesis and neuroplasticity, and thus may contribute to age-related health in the population. The current study focused on the "low normal" FMR1 genotype, defined by lower-than-typical numbers of FMR1 CGG repeats (<26), as a potential genetic determinant of age-related health. We characterized the effect of the low normal FMR1 genotype on psychological well-being and motor function in a racially diverse non-clinical sample of older adult women. Women with low CGG repeats were distinguished from those with CGGs falling within the mid-high end of the normal range by reduced performance on multimodal assessments of motor function and psychological well-being, with large effect sizes. Robust continuous associations were also detected between lower CGG repeat length and reduced psychological well-being, balance, and dexterity. Findings suggest that FMR1 may represent an important mediator of individual differences in age-related health; larger epidemiological studies are needed. Given that approximately 23-35% of females carry the low normal genotype, efforts to understand its clinical effects have relevance a broad swath of the aging population.
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Affiliation(s)
- Jessica Klusek
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Close-Hipp Building, 1705 College Street, Columbia, SC 29208, USA.
| | - Roger Newman-Norlund
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Close-Hipp Building, 1705 College Street, Columbia, SC 29208, USA; Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC 29208, USA
| | - Amanda J Fairchild
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, SC 29208, USA
| | - Sarah Newman-Norlund
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Close-Hipp Building, 1705 College Street, Columbia, SC 29208, USA
| | - Sara Sayers
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Close-Hipp Building, 1705 College Street, Columbia, SC 29208, USA
| | - Jill C Stewart
- Physical Therapy Program, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Elizabeth Berry-Kravis
- Department of Pediatrics, Neurological Sciences and Anatomy and Cell Biology, Rush University Medical Center, 1725 West Harrison Street, Suite 718, Chicago, IL 60612, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Close-Hipp Building, 1705 College Street, Columbia, SC 29208, USA
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Hocking DR, Loesch DZ, Stimpson P, Tassone F, Atkinson A, Storey E. Delineating the Relationships Between Motor, Cognitive-Executive and Psychiatric Symptoms in Female FMR1 Premutation Carriers. Front Psychiatry 2021; 12:742929. [PMID: 34925088 PMCID: PMC8678043 DOI: 10.3389/fpsyt.2021.742929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Premutation expansions (55-200 CGG repeats) of the Fragile X Mental Retardation 1 (FMR1) gene on the X chromosome are associated with a range of clinical features. Apart from the most severe - Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS) - where the most typical white matter changes affect cerebellar peduncles, more subtle changes may include impairment of executive functioning, affective disorders and/or subtle motor changes. Here we aimed to examine whether performance in selected components of executive functioning is associated with subclinical psychiatric symptoms in non-FXTAS, adult females carrying the FMR1 premutation. Methods and Sample: A total of 47 female premutation carriers (sub-symptomatic for FXTAS) of wide age range (26-77 years; M = 50.3; SD = 10.9) were assessed using standard neuropsychological tests, three motor rating scales and self-reported measures of psychiatric symptoms using the Symptom Checklist-90-Revised (SCL-90-R). Results: After adjusting for age and educational level where appropriate, both non-verbal reasoning and response inhibition as assessed on the Stroop task (i.e., the ability to resolve cognitive interference) were associated with a range of primary psychiatric symptom dimensions, and response inhibition uniquely predicted some primary symptoms and global psychiatric features. Importantly, lower scores (worse performance) in response inhibition were also strongly correlated with higher (worse) scores on standard motor rating scales for tremor-ataxia and for parkinsonism. Conclusion: These results provide evidence for the importance of response inhibition in the manifestation of psychiatric symptoms and subtle tremor-ataxia motor features, suggestive of the presence of early cerebellar changes in female premutation carriers.
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Affiliation(s)
- Darren R Hocking
- Developmental Neuromotor and Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Danuta Z Loesch
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Paige Stimpson
- Psychology Department, Monash Health, Clayton, VIC, Australia
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, School of Medicine and M.I.N.D. Institute, University of California Davis Medical Center, University of California, Davis, Davis, CA, United States
| | - Anna Atkinson
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Elsdon Storey
- Department of Medicine (Neuroscience), Monash University, Alfred Hospital Campus, Melbourne, VIC, Australia
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Moser C, Schmitt L, Schmidt J, Fairchild A, Klusek J. Response Inhibition Deficits in Women with the FMR1 Premutation are Associated with Age and Fall Risk. Brain Cogn 2020; 148:105675. [PMID: 33387817 DOI: 10.1016/j.bandc.2020.105675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/04/2020] [Accepted: 12/19/2020] [Indexed: 12/12/2022]
Abstract
One in 113-178 females worldwide carry a premutation allele on the FMR1 gene. The FMR1 premutation is linked to neurocognitive and neuromotor impairments, although the phenotype is not fully understood, particularly with respect to age effects. This study sought to define oculomotor response inhibition skills in women with the FMR1 premutation and their association with age and fall risk. We employed an antisaccade eye-tracking paradigm to index oculomotor inhibition skills in 35 women with the FMR1 premutation and 28 control women. The FMR1 premutation group exhibited longer antisaccade latency and reduced accuracy relative to controls, indicating deficient response inhibition skills. Longer response latency was associated with older age in the FMR1 premutation and was also predictive of fall risk. Findings highlight the utility of the antisaccade paradigm for detecting early signs of age-related executive decline in the FMR1 premutation, which is related to fall risk. Findings support the need for clinical prevention efforts to decrease and delay the trajectory of age-related executive decline in women with the FMR1 premutation during midlife.
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Affiliation(s)
- Carly Moser
- Communication Sciences and Disorders, University of South Carolina, 1705 College Street, Columbia, South Carolina, 29208, USA
| | - Lyndsay Schmitt
- Communication Sciences and Disorders, University of South Carolina, 1705 College Street, Columbia, South Carolina, 29208, USA
| | - Joseph Schmidt
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816, Orlando, Florida 32816, USA
| | - Amanda Fairchild
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Columbia, South Carolina, 29208, USA
| | - Jessica Klusek
- Communication Sciences and Disorders, University of South Carolina, 1705 College Street, Columbia, South Carolina, 29208, USA.
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Wang Z, Lane C, Terza M, Khemani P, Lui S, McKinney WS, Mosconi MW. Upper and Lower Limb Movement Kinematics in Aging FMR1 Gene Premutation Carriers. Brain Sci 2020; 11:E13. [PMID: 33374331 PMCID: PMC7823457 DOI: 10.3390/brainsci11010013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023] Open
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder associated with a premutation cytosine-guanine-guanine (CGG) trinucleotide repeat expansion of the FMR1 gene. FXTAS is estimated to be the most common single-gene form of ataxia in the aging population. Gait ataxia and intention tremor are the primary behavioral symptoms of FXTAS, though clinical evaluation of these symptoms often is subjective, contributing to difficulties in reliably differentiating individuals with FXTAS and asymptomatic premutation carriers. This study aimed to clarify the extent to which quantitative measures of gait and upper limb kinematics may serve as biobehavioral markers of FXTAS degeneration. Nineteen premutation carriers (aged 46-77 years), including 9 with possible, probable, or definite FXTAS and 16 sex- and IQ-matched healthy controls, completed tests of non-constrained walking and reaching while both standing (static reaching) and walking (dynamic reaching) to quantify gait and upper limb control, respectively. For the non-constrained walking task, participants wore reflective markers and walked at their preferred speed on a walkway. During the static reaching task, participants reached and lifted boxes of different sizes while standing. During the dynamic reaching task, participants walked to reach and lift the boxes. Movement kinematics were examined in relation to clinical ratings of neuromotor impairments and CGG repeat length. During non-constrained walking, individuals with FXTAS showed decreased stride lengths and stride velocities, increased percentages of double support time, and increased variabilities of cadence and center of mass relative to both asymptomatic premutation carriers and controls. While individuals with FXTAS did not show any static reaching differences relative to the other two groups, they showed multiple differences during dynamic reaching trials, including reduced maximum reaching velocity, prolonged acceleration time, and jerkier movement of the shoulder, elbow, and hand. Gait differences during non-constrained walking were associated with more severe clinically rated posture and gait symptoms. Reduced maximum reaching velocity and increased jerkiness during dynamic reaching were each related to more severe clinically rated kinetic dysfunction and overall neuromotor symptoms in FMR1 premutation carriers. Our findings suggest kinematic alterations consistent with gait ataxia and upper limb bradykinesia are each selectively present in individuals with FXTAS, but not asymptomatic aging premutation carriers. Consistent with neuropathological and magnetic resonance imaging (MRI) studies of FXTAS, these findings implicate cerebellar and basal ganglia degeneration associated with neuromotor decline. Our results showing associations between quantitative kinematic differences in FXTAS and clinical ratings suggest that objective assessments of gait and reaching behaviors may serve as critical and reliable targets for detecting FXTAS risk and monitoring progression.
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Affiliation(s)
- Zheng Wang
- Department of Occupational Therapy, University of Florida, Gainesville, FL 32611-0164, USA;
- Kansas Center for Autism Research and Training (K−CART) and Life Span Institute, University of Kansas, Lawrence, KS 66045, USA
| | - Callie Lane
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Matthew Terza
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611-8205, USA;
| | - Pravin Khemani
- Department of Neurology, Swedish Neuroscience Institute, Seattle, WA 98121, USA;
| | - Su Lui
- Huaxi Magnetic Resonance Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China;
| | - Walker S. McKinney
- Kansas Center for Autism Research and Training (K−CART) and Life Span Institute, University of Kansas, Lawrence, KS 66045, USA
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045, USA
| | - Matthew W. Mosconi
- Kansas Center for Autism Research and Training (K−CART) and Life Span Institute, University of Kansas, Lawrence, KS 66045, USA
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045, USA
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O'Keeffe C, Dominguez MC, O'Rourke E, Lynch T, Reilly RB. Decreased Theta Power Reflects Disruption in Postural Control Networks of Fragile X Premutation Carriers . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2845-2848. [PMID: 33018599 DOI: 10.1109/embc44109.2020.9176289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
FRM1 premutation carriers exhibit various subtle deficits in balance and stability, prior to the development of the movement disorder Fragile X Associated Tremor/Ataxia Syndrome (FXTAS). Force plate posturography has increasingly been combined with the temporal sensitive imaging methods such as EEG to offer insight into the neural mechanisms which govern postural control. This study investigated cortical theta power during continuous balance and its relationship to balance performance in Fragile X premutation carriers. Eight premutation carriers and 6 controls stood on a force platform under altered sensory and cognitive conditions while postural sway and high-density EEG data were simultaneously recorded. Carriers exhibited greater sway area when sensory input was reduced (p=0.01) and cognitive load was increased (p=0.01), as well as significantly reduced frontal theta power compared to the Control Group. The relationship between theta power and postural control seen in the control group may indicate an increase in error detection caused by reduced visual input and greater discrepancies between expected and actual balance state. While the lower theta power in frontal regions of carriers may indicate a disruption in neural networks underpinning postural control. Such results provide new insight into the neural correlates of balance control in Fragile X premutation carriers.
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Dominguez MC, O'Keeffe C, O'Rourke E, Feerick N, Reilly RB. Cortical Theta Activity and Postural Control in Non-Visual and High Cognitive Load Tasks: Impact for Clinical Studies. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1539-1542. [PMID: 31946187 DOI: 10.1109/embc.2019.8857663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Due to the major role of balance in our everyday lives and the unsatisfying understanding of the role of neural mechanism on balance control, the focus of this study was to explore the role of the cerebral cortex and its effects on stability. We investigated the effects of non-visual and cognitive tasks on balance performance and cortical theta response in a small, convenient sample. The cognitive tasks were N-back and Sustained Attention Response Task (SART). Cortical theta activity showed strong correlations with balance performance metrics. Particularly, central regions showed an increase in theta power in more cognitively challenging tasks but not statistically significant. Parietal theta power had a statistically significant increase in tasks that led to a heavier reliance on proprioception and vestibular information. This study shows the efficacy of EEG recording during balance control tasks. Future studies on neurodegenerative diseases that affect neuromotor control could investigate these outcomes.
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McKinney WS, Wang Z, Kelly S, Khemani P, Lui S, White SP, Mosconi MW. Precision Sensorimotor Control in Aging FMR1 Gene Premutation Carriers. Front Integr Neurosci 2019; 13:56. [PMID: 31632248 PMCID: PMC6783559 DOI: 10.3389/fnint.2019.00056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 09/18/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Individuals with premutation alleles of the FMR1 gene are at risk of developing fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative condition affecting sensorimotor function. Information on quantitative symptom traits associated with aging in premutation carriers is needed to clarify neurodegenerative processes contributing to FXTAS. MATERIALS AND METHODS 26 FMR1 premutation carriers ages 44-77 years and 31 age-matched healthy controls completed rapid (2 s) and sustained (8 s) visually guided precision gripping tasks. Individuals pressed at multiple force levels to determine the impact of increasing the difficulty of sensorimotor actions on precision behavior. During initial pressing, reaction time, the rate at which individuals increased their force, the duration of pressing, and force accuracy were measured. During sustained gripping, the complexity of the force time series, force variability, and mean force were examined. During relaxation, the rate at which individuals decreased their force was measured. We also examined the relationships between visuomotor behavior and cytosine-guanine-guanine (CGG) repeat length and clinically rated FXTAS symptoms. RESULTS Relative to controls, premutation carriers showed reduced rates of initial force generation during rapid motor actions and longer durations of their initial pressing with their dominant hand. During sustained force, premutation carriers demonstrated reduced force complexity, though this effect was specific to younger premutation carries during dominant hand pressing and was more severe for younger relative to older premutation carriers at low and medium force levels. Increased reaction time and lower sustained force complexity each were associated with greater CGG repeat length for premutation carriers. Increased reaction time and increased sustained force variability were associated with more severe clinically rated FXTAS symptoms. CONCLUSION Overall our findings suggest multiple sensorimotor processes are disrupted in aging premutation carriers, including initial force control guided by feedforward mechanisms and sustained sensorimotor behaviors guided by sensory feedback control processes. Results indicating that sensorimotor issues in aging premutation carriers relate to both greater CGG repeat length and clinically rated FXTAS symptoms suggest that quantitative tests of precision sensorimotor ability may serve as key targets for monitoring FXTAS risk and progression.
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Affiliation(s)
- Walker S. McKinney
- Clinical Child Psychology Program, Life Span Institute and Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, United States
| | - Zheng Wang
- Department of Occupational Therapy, University of Florida, Gainesville, FL, United States
| | - Shannon Kelly
- Clinical Child Psychology Program, Life Span Institute and Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, United States
| | - Pravin Khemani
- Department of Neurology, Swedish Neuroscience Institute, Seattle, WA, United States
| | - Su Lui
- Department of Radiology, Huaxi Magnetic Resonance Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Stormi P. White
- Department of Pediatrics, Marcus Autism Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Matthew W. Mosconi
- Clinical Child Psychology Program, Life Span Institute and Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, United States
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13
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O'Keeffe C, Taboada LP, Feerick N, Gallagher L, Lynch T, Reilly RB. Complexity based measures of postural stability provide novel evidence of functional decline in fragile X premutation carriers. J Neuroeng Rehabil 2019; 16:87. [PMID: 31299981 PMCID: PMC6624948 DOI: 10.1186/s12984-019-0560-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/26/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Fragile X Associated Tremor/Ataxia Syndrome (FXTAS) is a neurodegenerative movement disorder characterized by tremor, ataxic gait, and balance issues resulting from a premutation of the Fragile X Mental Retardation 1 (FMR1) gene. No biomarkers have yet been identified to allow early diagnosis of FXTAS, however, recent studies have reported subtle issues in the stability of younger premutation carriers, before disease onset. This study investigates the efficacy of multiscale entropy analysis (MSE) in detecting early changes in the motor system of premutation carriers without FXTAS. METHODS Sway complexity of 12 female Premutation carriers and 15 healthy Controls were measured under four conditions: eyes open, closed, and two dual-task conditions. A Sustained Attention Response Task (SART) and a working memory based N-Back task were employed to increase cognitive load while standing on the forceplate. A Complexity Index (Ci) was calculated for anterior-posterior (AP) and mediolateral (ML) sway. Independent t-tests were used to assess between-group differences and Oneway repeated measures ANOVA were used to assess within group differences with Bonferroni corrections to adjust for multiple comparisons. RESULTS Group performances were comparable with eyes open and closed conditions. The Carrier group's Ci was consistent across tasks and conditions while the Control group's AP Ci increased significantly during the cognitive dual-task (p = 0.001). There was also a strong correlation between CGG repeat length and complexity for the Carrier group (p = 0.004). SIGNIFICANCE Increased sway complexity is believed to stem from reallocation of attention to facilitate the increased cognitive demands of dual-tasks. Carriers' complexity did not change during dual-tasks, possibly indicating capacity interference and inefficient division of attention. Lower sway complexity in carriers suggests diminished adaptive capacity under stress as well as degradation of motor functioning. Therefore, sway complexity may be a useful tool in identifying early functional decline in FMR1 premutation carriers as well as monitoring progression towards disease onset.
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Affiliation(s)
- Clodagh O'Keeffe
- Trinity Centre for Biomedical Engineering, Trinity College, The University of Dublin, 152 - 160 Pearse St, Dublin 2, Ireland. .,School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland.
| | - Laura P Taboada
- Trinity Centre for Biomedical Engineering, Trinity College, The University of Dublin, 152 - 160 Pearse St, Dublin 2, Ireland.,School of Engineering, Trinity College, The University of Dublin, Dublin, Ireland
| | - Niamh Feerick
- Trinity Centre for Biomedical Engineering, Trinity College, The University of Dublin, 152 - 160 Pearse St, Dublin 2, Ireland.,School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland
| | - Louise Gallagher
- School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland.,Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Timothy Lynch
- The Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland.,Centre for Neuroscience, Conway Institute, University College Dublin, Dublin, Ireland.,Mater Misericordiae University Hospital, Dublin, Ireland
| | - Richard B Reilly
- Trinity Centre for Biomedical Engineering, Trinity College, The University of Dublin, 152 - 160 Pearse St, Dublin 2, Ireland.,School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland.,School of Engineering, Trinity College, The University of Dublin, Dublin, Ireland
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14
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Winser S, Pang MYC, Rauszen JS, Chan AYY, Chen CH, Whitney SL. Does integrated cognitive and balance (dual-task) training improve balance and reduce falls risk in individuals with cerebellar ataxia? Med Hypotheses 2019; 126:149-153. [PMID: 31010491 DOI: 10.1016/j.mehy.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/04/2019] [Indexed: 12/24/2022]
Abstract
Frequent falls in people with cerebellar ataxia (CA) is a significant problem Therefore, an intervention that could improve balance and reduce the number of falls is of paramount importance from the patients' perspective. Combining cognitive training with physical training to improve balance is a new approach for reducing the risk of falls in patient populations who are at risk for falls. To determine if adding structured cognitive demands to conventional balance and coordination training we designed the Cognitive-coupled Intensive Balance Training (CIBT) program. We found that the more intensive and focused CIBT intervention reduced dual-task cost, improved balance, and reduced the number of falls in a sample of individuals with CA. We hypothesize that (1) CIBT will improve balance and reduce falls; and (2) CIBT will be a cost-effective treatment option for improving balance and reduce falls. To test these hypotheses, we propose conducting a randomized controlled trial (RCT) with economic evaluation . This paper reports the findings of our study testing the feasibility of the CIBT program, rationale for testing our hypothesis and an overview of our future study design to test the effectiveness and cost-effectiveness of the CIBT program.
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Affiliation(s)
- Stanley Winser
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong.
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong
| | - Jessica S Rauszen
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong
| | - Anne Y Y Chan
- Division of Neurology, Prince of Wales Hospital and Honorary Clinical Assistant Professor Dept. of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
| | - Cynthia Huijun Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Susan L Whitney
- School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
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15
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Wang Z, Khemani P, Schmitt LM, Lui S, Mosconi MW. Static and dynamic postural control deficits in aging fragile X mental retardation 1 (FMR1) gene premutation carriers. J Neurodev Disord 2019; 11:2. [PMID: 30665341 PMCID: PMC6341725 DOI: 10.1186/s11689-018-9261-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/26/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Individuals with premutation alleles of the fragile X mental retardation 1 (FMR1) gene are at risk of developing fragile X-associated tremor/ataxia syndrome (FXTAS) during aging. Characterization of motor issues associated with aging in FMR1 premutation carriers is needed to determine neurodegenerative processes and establish new biobehavioral indicators to help identify individuals at greatest risk of developing FXTAS. METHODS We examined postural stability in 18 premutation carriers ages 46-77 years and 14 age-matched healthy controls. Participants completed a test of static stance and two tests of dynamic postural sway on a force platform to quantify postural variability and complexity. CGG repeat length was measured for each premutation carrier, and MRI and neurological evaluations were conducted to identify carriers who currently met criteria for FXTAS. Of the 18 premutation carriers, seven met criteria for definite/probable FXTAS (FXTAS+), seven showed no MRI or neurological signs of FXTAS (FXTAS-), and four were inconclusive due to insufficient data. RESULTS Compared to controls, premutation carriers showed increased center of pressure (COP) variability in the mediolateral (COPML) direction during static stance and reduced COP variability in the anterior-posterior (COPAP) direction during dynamic AP sway. They also showed reductions in COPML complexity during each postural condition. FXTAS+ individuals showed reduced COPAP variability compared to FXTAS- carriers and healthy controls during dynamic AP sway. Across all carriers, increased sway variability during static stance and decreased sway variability in target directions during dynamic sways were associated with greater CGG repeat length and more severe neurologically rated posture and gait abnormalities. CONCLUSION Our findings indicate that aging FMR1 premutation carriers show static and dynamic postural control deficits relative to healthy controls implicating degenerative processes of spinocerebellar and cerebellar-brainstem circuits that may be independent of or precede the onset of FXTAS. Our finding that FXTAS+ and FXTAS- premutation carriers differed on their level of intentional AP sway suggests that neural mechanisms of dynamic postural control may be differentially impacted in patients with FXTAS, and its measurement may be useful for rapidly and precisely identifying disease presence and onset.
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Affiliation(s)
- Zheng Wang
- Department of Occupational Therapy, University of Florida, Gainesville, FL, 32611, USA. .,University of Florida, 1225 Center Drive, PO Box 100164, Gainesville, FL, 326100164, USA.
| | - Pravin Khemani
- Department of Neurology, Swedish Neuroscience Institute, Seattle, WA, 98121, USA
| | - Lauren M Schmitt
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Su Lui
- Huaxi Magnetic Resonance Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Matthew W Mosconi
- Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, 66045, USA.,Clinical Child Psychology Program, University of Kansas, Lawrence, KS, 66045, USA.,Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, 66045, USA
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16
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Brain structure and intragenic DNA methylation are correlated, and predict executive dysfunction in fragile X premutation females. Transl Psychiatry 2016; 6:e984. [PMID: 27959330 PMCID: PMC5290342 DOI: 10.1038/tp.2016.250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/28/2016] [Indexed: 02/07/2023] Open
Abstract
DNA methylation of the Fragile X mental retardation 1 (FMR1) exon 1/intron 1 boundary has been associated with executive dysfunction in female carriers of a FMR1 premutation (PM: 55-199 CGG repeats), whereas neuroanatomical changes have been associated with executive dysfunction in PM males. To our knowledge, this study for the first time examined the inter-relationships between executive function, neuroanatomical structure and molecular measures (DNA methylation and FMR1 mRNA levels in blood) in PM and control (<44 CGG repeats) females. In the PM group, FMR1 intron 1 methylation was positively associated with executive function and cortical thickness in middle and superior frontal gyri, and left inferior parietal gyrus. By contrast, in the control group, FMR1 intron 1 methylation was negatively associated with cortical thickness of the left middle frontal gyrus and superior frontal gyri. No significant associations were revealed for either group between FMR1 mRNA and neuroanatomical structure or executive function. In the PM group, the lack of any significant association between FMR1 mRNA levels and phenotypic measures found in this study suggests that either FMR1 expression is not well conserved between tissues, or that FMR1 intron 1 methylation is linked to neuroanatomical and cognitive phenotype in PM females via a different mechanism.
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17
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Cerebellar volume mediates the relationship between FMR1 mRNA levels and voluntary step initiation in males with the premutation. Neurobiol Aging 2016; 50:5-12. [PMID: 27837676 DOI: 10.1016/j.neurobiolaging.2016.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/31/2016] [Accepted: 10/08/2016] [Indexed: 01/14/2023]
Abstract
Recent evidence indicates that adults with a premutation (PM: 55-199 CGG repeats) expansion in the fragile X mental retardation 1 (FMR1) gene show postural control deficits that may reflect disruption to cerebellar motor regions. Less is known about the influence of reduced cerebellar volume and structural changes, and increase in CGG repeat and FMR1 mRNA levels on the attentional demands of step initiation in PM males. We investigated the effects of a concurrent cognitive task on choice stepping reaction time (CSRT) and explored the associations between CSRT performance, cerebellar volume, CGG size, and FMR1 mRNA levels in blood in PM males. We examined 19 PM males (ages 28-75) and 23 matched controls (CGG <44; ages 26-77), who performed a verbal fluency task during CSRT performance and single-task stepping without a secondary cognitive task. Our results provide preliminary evidence that smaller cerebellar volume (β = -2.73, p = 0.002) and increasing CGG repeat length (β = 1.69, p = 0.003) were associated with greater dual-task step initiation times in PM males, but not in controls. There was evidence of a mediating effect of cerebellar volume on the relationship between FMR1 mRNA levels and single-task CSRT performance in PM males (estimate coefficient = 8.69, standard error = 4.42, p = 0.049). These findings suggest increasing CGG repeat and FMR1 mRNA levels have neurotoxic effects on cerebellar regions underlying anticipatory postural responses during stepping. Cerebellar postural changes may be predictive of the increased risk of falls in older PM males.
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18
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Foote M, Arque G, Berman RF, Santos M. Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS) Motor Dysfunction Modeled in Mice. CEREBELLUM (LONDON, ENGLAND) 2016; 15:611-22. [PMID: 27255703 PMCID: PMC5014696 DOI: 10.1007/s12311-016-0797-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder that affects some carriers of the fragile X premutation (PM). In PM carriers, there is a moderate expansion of a CGG trinucleotide sequence (55-200 repeats) in the fragile X gene (FMR1) leading to increased FMR1 mRNA and small to moderate decreases in the fragile X mental retardation protein (FMRP) expression. The key symptoms of FXTAS include cerebellar gait ataxia, kinetic tremor, sensorimotor deficits, neuropsychiatric changes, and dementia. While the specific trigger(s) that causes PM carriers to progress to FXTAS pathogenesis remains elusive, the use of animal models has shed light on the underlying neurobiology of the altered pathways involved in disease development. In this review, we examine the current use of mouse models to study PM and FXTAS, focusing on recent advances in the field. Specifically, we will discuss the construct, face, and predictive validities of these PM mouse models, the insights into the underlying disease mechanisms, and potential treatments.
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Affiliation(s)
- Molly Foote
- Department of Neurological Surgery, University of California, Davis, CA, USA.
| | - Gloria Arque
- Department of Molecular Neuroscience, Medical University of Vienna, Vienna, Austria
| | - Robert F Berman
- Department of Neurological Surgery, University of California, Davis, CA, USA
| | - Mónica Santos
- Institute of Biology, Otto-von-Guericke University, Magdeburg, Germany
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19
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Characterization and Early Detection of Balance Deficits in Fragile X Premutation Carriers With and Without Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS). THE CEREBELLUM 2016; 14:650-62. [PMID: 25763861 DOI: 10.1007/s12311-015-0659-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) results from a "premutation" size 55-200 CGG repeat expansion in the fragile X mental retardation 1 (FMR1) gene. Core motor features include cerebellar gait ataxia and kinetic tremor, resulting in progressive mobility disability. There are no published studies characterizing balance deficits in FMR1 premutation carriers with and without FXTAS using a battery of quantitative measures to test the sensory integration underlying postural control, automatic postural reflexes, and dynamic postural stability limits. Computerized dynamic posturography (CDP) and two performance-based balance measures were administered in 44 premutation carriers, 21 with FXTAS and 23 without FXTAS, and 42 healthy controls to compare balance and functional mobility between these groups. Relationships between FMR1 molecular variables, age, and sex and CDP scores were explored. FXTAS subjects demonstrated significantly lower scores on the sensory organization test (with greatest reductions in the vestibular control of balance), longer response latencies to balance perturbations, and reduced stability limits compared to controls. Premutation carriers without FXTAS also demonstrated significantly delayed response latencies and disrupted sensory weighting for balance control. Advancing age, male sex, increased CGG repeat size, and reduced X activation of the normal allele in premutation carrier women predicted balance dysfunction. These postural control deficits in carriers with and without FXTAS implicate dysfunctional cerebellar neural networks and may provide valuable outcome markers for tailored rehabilitative interventions. Our findings suggest that CDP may provide sensitive measures for early detection of postural control impairments in at-risk carriers and better characterize balance dysfunction and progression in FXTAS.
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20
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Birch RC, Hocking DR, Cornish KM, Menant JC, Georgiou-Karistianis N, Godler DE, Wen W, Hackett A, Rogers C, Trollor JN. Preliminary evidence of an effect of cerebellar volume on postural sway in FMR1 premutation males. GENES BRAIN AND BEHAVIOR 2015; 14:251-9. [PMID: 25689687 DOI: 10.1111/gbb.12204] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/27/2015] [Accepted: 01/28/2015] [Indexed: 11/29/2022]
Abstract
Recent evidence suggests that early changes in postural control may be discernible among females with premutation expansions (55-200 CGG repeats) of the fragile X mental retardation 1 (FMR1) gene at risk of developing fragile X-associated tremor ataxia syndrome (FXTAS). Cerebellar dysfunction is well described in males and females with FXTAS, yet the interrelationships between cerebellar volume, CGG repeat length, FMR1 messenger RNA (mRNA) levels and changes in postural control remain unknown. This study examined postural sway during standing in a cohort of 22 males with the FMR1 premutation (ages 26-80) and 24 matched controls (ages 26-77). The influence of cerebellar volume, CGG repeat length and FMR1 mRNA levels on postural sway was explored using multiple linear regression. The results provide preliminary evidence that increasing CGG repeat length and decreasing cerebellar volume were associated with greater postural sway among premutation males. The relationship between CGG repeat length and postural sway was mediated by a negative association between CGG repeat size and cerebellar volume. While FMR1 mRNA levels were significantly elevated in the premutation group and correlated with CGG repeat length, FMR1 mRNA levels were not significantly associated with postural sway scores. These findings show for the first time that greater postural sway among males with the FMR1 premutation may reflect CGG repeat-mediated disruption in vulnerable cerebellar circuits implicated in postural control. However, longitudinal studies in larger samples are required to confirm whether the relationships between cerebellar volume, CGG repeat length and postural sway indicate greater risk for neurological decline.
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Affiliation(s)
- R C Birch
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney
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21
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Cornish KM, Kraan CM, Bui QM, Bellgrove MA, Metcalfe SA, Trollor JN, Hocking DR, Slater HR, Inaba Y, Li X, Archibald AD, Turbitt E, Cohen J, Godler DE. Novel methylation markers of the dysexecutive-psychiatric phenotype in FMR1 premutation women. Neurology 2015; 84:1631-8. [PMID: 25809302 DOI: 10.1212/wnl.0000000000001496] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/08/2014] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To examine the epigenetic basis of psychiatric symptoms and dysexecutive impairments in FMR1 premutation (PM: 55 to 199 CGG repeats) women. METHODS A total of 35 FMR1 PM women aged between 22 and 55 years and 35 age- and IQ-matched women controls (CGG <45) participated in this study. All participants completed a range of executive function tests and self-reported symptoms of psychiatric disorders. The molecular measures included DNA methylation of the FMR1 CpG island in blood, presented as FMR1 activation ratio (AR), and 9 CpG sites located at the FMR1 exon1/intron 1 boundary, CGG size, and FMR1 mRNA levels. RESULTS We show that FMR1 intron 1 methylation levels could be used to dichotomize PM women into greater and lower risk categories (p = 0.006 to 0.037; odds ratio = 14-24.8), with only FMR1 intron 1 methylation, and to a lesser extent AR, being significantly correlated with the likelihood of probable dysexecutive or psychiatric symptoms (p < 0.05). Furthermore, the significant relationships between methylation and social anxiety were found to be mediated by executive function performance, but only in PM women. FMR1 exon 1 methylation, CGG size, and FMR1 mRNA could not predict probable dysexecutive/psychiatric disorders in PM women. CONCLUSIONS This is the first study supporting presence of specific epigenetic etiology associated with increased risk of developing comorbid dysexecutive and social anxiety symptoms in PM women. These findings could have implications for early intervention and risk estimate recommendations aimed at improving the outcomes for PM women and their families.
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Affiliation(s)
- Kim M Cornish
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia.
| | - Claudine M Kraan
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Quang Minh Bui
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Mark A Bellgrove
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Sylvia A Metcalfe
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Julian N Trollor
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Darren R Hocking
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Howard R Slater
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Yoshimi Inaba
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Xin Li
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Alison D Archibald
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Erin Turbitt
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Jonathan Cohen
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - David E Godler
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
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22
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Shelton AL, Cornish KM, Godler DE, Clough M, Kraan C, Bui M, Fielding J. Delineation of the working memory profile in female FMR1 premutation carriers: the effect of cognitive load on ocular motor responses. Behav Brain Res 2015; 282:194-200. [PMID: 25591477 DOI: 10.1016/j.bbr.2015.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/17/2014] [Accepted: 01/06/2015] [Indexed: 01/10/2023]
Abstract
Fragile X mental retardation 1 (FMR1) premutation carriers (PM-carriers) are characterised as having mid-sized expansions of between 55 and 200 CGG repeats in the 5' untranslated region of the FMR1 gene. While there is evidence of executive dysfunction in PM-carriers, few studies have explicitly explored working memory capabilities in female PM-carriers. 14 female PM-carriers and 13 age- and IQ-matched healthy controls completed an ocular motor n-back working memory paradigm. This task examined working memory ability and the effect of measured increases in cognitive load. Female PM-carriers were found to have attenuated working memory capabilities. Increasing the cognitive load did not elicit the expected reciprocal increase in the task errors for female PM-carriers, as it did in controls. However female PM-carriers took longer to respond than controls, regardless of the cognitive load. Further, FMR1 mRNA levels were found to significantly predict PM-carrier response time. Although preliminary, these findings provide further evidence of executive dysfunction, specifically disruption to working memory processes, which were found to be associated with increases in FMR1 mRNA expression in female PM-carriers. With future validation, ocular motor paradigms such as the n-back paradigm will be critical to the development of behavioural biomarkers for identification of PM-carrier cognitive-affective phenotypes.
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Affiliation(s)
- Annie L Shelton
- School of Psychological Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Kim M Cornish
- School of Psychological Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - David E Godler
- Cyto-molecular Diagnostic Research Laboratory, Victorian Clinical Genetics Services and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne 3052, VIC, Australia
| | - Meaghan Clough
- School of Psychological Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Claudine Kraan
- School of Psychological Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Minh Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, VIC, Australia
| | - Joanne Fielding
- School of Psychological Science, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
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23
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Hocking DR, Kraan CM, Godler DE, Bui QM, Li X, Bradshaw JL, Georgiou-Karistianis N, Metcalfe SA, Archibald AD, Turbitt E, Fielding J, Trollor J, Cohen J, Cornish KM. Evidence linking FMR1 mRNA and attentional demands of stepping and postural control in women with the premutation. Neurobiol Aging 2014; 36:1400-8. [PMID: 25541421 DOI: 10.1016/j.neurobiolaging.2014.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/25/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022]
Abstract
Recent studies in young adult females with the fragile X mental retardation 1 (FMR1) gene premutation (PM) have shown subtle but significant impairments in executive control and postural stability. Less is known about the influence of age and FMR1 gene expression on executive control and postural stability in females with the PM. Here, we examined the attentional demands of reactive stepping using a well-validated measure of choice stepping reaction time under dual-task interference. We explored the interrelationships between step initiation times during a concurrent verbal fluency task and specific impairments in executive control previously reported in females with the PM. Our results showed increased dual-task interference on step initiation times and variability in female PM compared with control subjects. In addition, we observed greater choice stepping reaction time dual-task costs above the breakpoint of 81 CGG repeats relative to below this CGG range. Dual-task interference on both reaction time and movement time were significantly predicted by low working memory capacity in female PM carriers. Importantly, we revealed that FMR1 messenger RNA level is the most significant predictor accounting for dual-task stepping variability in both reaction time and movement time in PM females. These findings for the first time provide evidence linking elevated FMR1 messenger RNA levels that have been previously associated with FMR1 RNA toxicity and deficits in cerebellar motor and cognitive networks in a subgroup of at-risk PM women.
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Affiliation(s)
- Darren R Hocking
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Bundoora, Victoria, Australia.
| | - Claudine M Kraan
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - David E Godler
- Cyto-molecular Diagnostics Research, Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Quang M Bui
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Xin Li
- Cyto-molecular Diagnostics Research, Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - John L Bradshaw
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Sylvia A Metcalfe
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Alison D Archibald
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; Victorian Clinical Genetics Services, Parkville, Victoria, Australia
| | - Erin Turbitt
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Joanne Fielding
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Jonathan Cohen
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Centre for Developmental Disability Health Victoria, Monash University, Clayton, Victoria, Australia; Fragile X Alliance Inc (Clinic and Resource Centre), North Caulfield, Victoria, Australia
| | - Kim M Cornish
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
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24
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Muzar Z, Lozano R. Current research, diagnosis, and treatment of fragile X-associated tremor/ataxia syndrome. Intractable Rare Dis Res 2014; 3:101-9. [PMID: 25606360 PMCID: PMC4298640 DOI: 10.5582/irdr.2014.01029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 11/30/2014] [Indexed: 12/13/2022] Open
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is caused by a premutation CGG-repeat expansion in the 5'UTR of the fragile X mental retardation 1 (FMR1) gene. The classical clinical manifestations include tremor, cerebellar ataxia, cognitive decline and psychiatric disorders. Other less frequent features are peripheral neuropathy and autonomic dysfunction. Cognitive decline, a form of frontal subcortical dementia, memory loss and executive function deficits are also characteristics of this disorder. In this review, we present an expansion of recommendations for genetic testing for adults with suspected premutation disorders and provide an update of the clinical, radiological and molecular research of FXTAS, as well as the current research in the treatment for this intractable complex neurodegenerative genetic disorder.
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Affiliation(s)
- Zukhrofi Muzar
- UC Davis MIND Institute and Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA
| | - Reymundo Lozano
- UC Davis MIND Institute and Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA
- Address correspondence to: Dr. Reymundo Lozano, UC Davis MIND Institute and Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA. E-mail:
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25
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Grigsby J, Cornish K, Hocking D, Kraan C, Olichney JM, Rivera SM, Schneider A, Sherman S, Wang JY, Yang JC. The cognitive neuropsychological phenotype of carriers of the FMR1 premutation. J Neurodev Disord 2014; 6:28. [PMID: 25136377 PMCID: PMC4135346 DOI: 10.1186/1866-1955-6-28] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
The fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder affecting a subset of carriers of the FMR1 (fragile X mental retardation 1) premutation. Penetrance and expression appear to be significantly higher in males than females. Although the most obvious aspect of the phenotype is the movement disorder that gives FXTAS its name, the disorder is also accompanied by progressive cognitive impairment. In this review, we address the cognitive neuropsychological and neurophysiological phenotype for males and females with FXTAS, and for male and female unaffected carriers. Despite differences in penetrance and expression, the cognitive features of the disorder appear similar for both genders, with impairment of executive functioning, working memory, and information processing the most prominent. Deficits in these functional systems may be largely responsible for impairment on other measures, including tests of general intelligence and declarative learning. FXTAS is to a large extent a white matter disease, and the cognitive phenotypes observed are consistent with what some have described as white matter dementia, in contrast to the impaired cortical functioning more characteristic of Alzheimer's disease and related disorders. Although some degree of impaired executive functioning appears to be ubiquitous among persons with FXTAS, the data suggest that only a subset of unaffected carriers of the premutation - both female and male - demonstrate such deficits, which typically are mild. The best-studied phenotype is that of males with FXTAS. The manifestations of cognitive impairment among asymptomatic male carriers, and among women with and without FXTAS, are less well understood, but have come under increased scrutiny.
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Affiliation(s)
- Jim Grigsby
- Department of Psychology, University of Colorado Denver, Denver, CO, USA ; Department of Medicine; Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kim Cornish
- School of Psychology & Psychiatry; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Darren Hocking
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia
| | - Claudine Kraan
- School of Psychology & Psychiatry; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - John M Olichney
- Center for Mind and Brain, University of California, Davis, CA, USA ; Department of Neurology, University of California, Davis, Sacramento, CA, USA
| | - Susan M Rivera
- Center for Mind and Brain, University of California, Davis, CA, USA ; Department of Psychology, University of California-Davis, Sacramento, CA, USA ; MIND Institute, University of California-Davis Medical Center, Sacramento, CA, USA
| | - Andrea Schneider
- Center for Mind and Brain, University of California, Davis, CA, USA ; MIND Institute, University of California-Davis Medical Center, Sacramento, CA, USA
| | | | - Jun Yi Wang
- Center for Mind and Brain, University of California, Davis, CA, USA ; Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
| | - Jin-Chen Yang
- Center for Mind and Brain, University of California, Davis, CA, USA ; Department of Neurology, University of California, Davis, Sacramento, CA, USA
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26
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Besterman AD, Wilke SA, Mulligan TE, Allison SC, Hagerman R, Seritan AL, Bourgeois JA. Towards an Understanding of Neuropsychiatric Manifestations in Fragile X Premutation Carriers. FUTURE NEUROLOGY 2014; 9:227-239. [PMID: 25013385 DOI: 10.2217/fnl.14.11] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Fragile X-associated disorders (FXD) are a group of disorders caused by expansion of non-coding CGG repeat elements in the fragile X (FMR1) gene. One of these disorders, fragile X syndrome (FXS), is the most common heritable cause of intellectual disability, and is caused by large CGG repeat expansions (>200) resulting in silencing of the FMR1 gene. An increasingly recognized number of neuropsychiatric FXD have recently been identified that are caused by 'premutation' range expansions (55-200). These disorders are characterized by a spectrum of neuropsychiatric manifestations ranging from an increased risk of neurodevelopmental, mood and anxiety disorders to neurodegenerative phenotypes such as the fragile X-associated tremor ataxia syndrome (FXTAS). Here, we review advances in the clinical understanding of neuropsychiatric disorders in premutation carriers across the lifespan and offer guidance for the detection of such disorders by practicing psychiatrists and neurologists.
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Affiliation(s)
- Aaron D Besterman
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, California 94143 USA
| | - Scott A Wilke
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, California 94143 USA
| | - Tua-Elisabeth Mulligan
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, California 94143 USA
| | - Stephen C Allison
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, California 94143 USA
| | - Randi Hagerman
- Department of Pediatrics and MIND Institute, University of California Davis, Sacramento, California 95817 USA
| | - Andreea L Seritan
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis, Sacramento, California 95817 USA
| | - James A Bourgeois
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, California 94143 USA
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27
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Polussa J, Schneider A, Hagerman R. Molecular Advances Leading to Treatment Implications for Fragile X Premutation Carriers. BRAIN DISORDERS & THERAPY 2014; 3:1000119. [PMID: 25436181 PMCID: PMC4245015 DOI: 10.4172/2168-975x.1000119] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fragile X syndrome (FXS) is the most common single gene cause of intellectual disability and it is characterized by a CGG expansion of more than 200 repeats in the FMR1 gene, leading to methylation of the promoter and gene silencing. The fragile X premutation, characterized by a 55 to 200 CGG repeat expansion, causes health problems and developmental difficulties in some, but not all, carriers. The premutation causes primary ovarian insufficiency in approximately 20% of females, psychiatric problems (including depression and/or anxiety) in approximately 50% of carriers and a neurodegenerative disorder, the fragile X-associated tremor ataxia syndrome (FXTAS), in approximately 40% of males and 16% of females later in life. Recent clinical studies in premutation carriers have expanded the health problems that may be seen. Advances in the molecular pathogenesis of the premutation have shown significant mitochondrial dysfunction and oxidative stress in neurons which may be amenable to treatment. Here we review the clinical problems of carriers and treatment recommendations.
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Affiliation(s)
- Jonathan Polussa
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health System, Sacramento, California, USA
- Department of Pediatrics, University of California Davis Health System, Sacramento, California, USA
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health System, Sacramento, California, USA
- Department of Pediatrics, University of California Davis Health System, Sacramento, California, USA
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health System, Sacramento, California, USA
- Department of Pediatrics, University of California Davis Health System, Sacramento, California, USA
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