1
|
Cotogni M, Sacchi L, Sadikov A, Georgiev D. Asymmetry at Disease Onset Is Not a Predictor of Parkinson's Disease Progression. JOURNAL OF PARKINSONS DISEASE 2021; 11:1689-1694. [PMID: 34250949 DOI: 10.3233/jpd-202525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Even though a significant fraction of Parkinson's disease (PD) patients presents with only minor or no motor asymmetry, the motor symptoms in PD typically start on one side of the body and worse symptoms on the side of the disease onset usually persist long after the disease has become clinically bilateral. The asymmetric presentation of PD has been studied over the years, with some studies showing slower progression in PD subjects with asymmetric disease presentation. In other studies, however, it was not possible to relate the asymmetry to disease progression. OBJECTIVE The main objective of the present study was to assess the effect of asymmetry at disease onset on disease progression. METHODS Using the data available in the Parkinson's Progression Markers Initiative (PPMI) database, at baseline, 423 subjects with de-novo PD were included in the study. Instead of dichotomizing the subjects in asymmetric and symmetric, we kept the asymmetry index and the non-motor, disability, and motor progression at one-, three-, and five-year follow-up continuous. Linear regression was used to correlate asymmetry indices and disease progression. RESULTS There was no correlation between neither clinically, nor DatSCAN defined asymmetry and non-motor, motor, and disability progression in the de-novo PD subjects with a 5-year follow-up. CONCLUSION Asymmetry does not predict progression of PD. Further studies are needed to investigate whether early detection of asymmetry on clinical grounds could successfully distinguish between PD and symmetric types of atypical parkinsonism in the early stages of the disease.
Collapse
Affiliation(s)
- Marco Cotogni
- Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia.,Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Lucia Sacchi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Aleksander Sadikov
- Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| | - Dejan Georgiev
- Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia.,Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
2
|
Zhu S, Zhong M, Bai Y, Wu Z, Gu R, Jiang X, Shen B, Zhu J, Pan Y, Dong J, Xu P, Yan J, Zhang L. The Association Between Clinical Characteristics and Motor Symptom Laterality in Patients With Parkinson's Disease. Front Neurol 2021; 12:663232. [PMID: 34135850 PMCID: PMC8201506 DOI: 10.3389/fneur.2021.663232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose: The unilateral onset and persistent asymmetry of motor symptoms are important characteristics of Parkinson's disease (PD). By using scales and wearable sensors, this study explored whether motor symptom laterality could affect non-motor symptom and gait performance. Methods: A total of 130 right-handed patients with PD were enrolled in our study and were divided into two groups according to the side of predominant motor symptom presentation by using the Unified Parkinson's Disease Rating Scale part III. We measured the non-motor symptoms with the Non-motor symptoms Scale, sleep quality with the Parkinson's Disease Sleep Scale and Pittsburgh sleep quality index, cognitive function with the Mini-mental State Examination and Montreal Cognitive Assessment, quality of life with the Parkinson's Disease Questionnaire-39, and the severity of anxiety and depression with the Hamilton Anxiety Scale and Hamilton Depression Scale, respectively. All participants underwent the instrumented stand and walk test, and gait data were collected using a set of JiBuEn gait analysis system. Results: We observed that left-dominant symptom PD patients (LPD) were associated with a greater impairment of sleep quality than right-dominant symptom PD patients (RPD). We found no difference between LPD and RPD in terms of gait performance. However, compared with the severe asymmetry RPD patients (RPD-S), severe asymmetry LPD patients (LPD-S) showed a shorter stride length and decreased range of motion of hip joints. Conclusions: In this study, LPD was associated with a more severe sleep-related dysfunction than RPD. In addition, LPD-S exhibited more gait impairments than RPD-S. Considering that motor symptom laterality may affect the non-motor symptom and gait performance, it should be taken into account when evaluating and treating PD patients.
Collapse
Affiliation(s)
- Sha Zhu
- Department of Geriatrics, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Min Zhong
- Department of Geriatrics, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Yu Bai
- Department of Biological Sciences, University of Toronto Scarborough, Toronto, ON, Canada
| | - Zhuang Wu
- Department of Geriatrics, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Ruxin Gu
- Department of Geriatrics, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Xu Jiang
- Department of Geriatrics, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Bo Shen
- Department of Geriatrics, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Jun Zhu
- Department of Geriatrics, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Yang Pan
- Department of Geriatrics, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Jingde Dong
- Department of Geriatrics, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Pingyi Xu
- Department of Neurology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jun Yan
- Department of Geriatrics, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Li Zhang
- Department of Geriatrics, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| |
Collapse
|
3
|
Epigenomic analysis of Parkinson's disease neurons identifies Tet2 loss as neuroprotective. Nat Neurosci 2020; 23:1203-1214. [PMID: 32807949 DOI: 10.1038/s41593-020-0690-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 07/07/2020] [Indexed: 01/08/2023]
Abstract
Parkinson's disease (PD) pathogenesis may involve the epigenetic control of enhancers that modify neuronal functions. Here, we comprehensively examine DNA methylation at enhancers, genome-wide, in neurons of patients with PD and of control individuals. We find a widespread increase in cytosine modifications at enhancers in PD neurons, which is partly explained by elevated hydroxymethylation levels. In particular, patients with PD exhibit an epigenetic and transcriptional upregulation of TET2, a master-regulator of cytosine modification status. TET2 depletion in a neuronal cell model results in cytosine modification changes that are reciprocal to those observed in PD neurons. Moreover, Tet2 inactivation in mice fully prevents nigral dopaminergic neuronal loss induced by previous inflammation. Tet2 loss also attenuates transcriptional immune responses to an inflammatory trigger. Thus, widespread epigenetic dysregulation of enhancers in PD neurons may, in part, be mediated by increased TET2 expression. Decreased Tet2 activity is neuroprotective, in vivo, and may be a new therapeutic target for PD.
Collapse
|
4
|
Massa J, Chahine LM. Revision of Diagnosis in Early Parkinsonism with Abnormal Dopamine Transporter Imaging. JOURNAL OF PARKINSONS DISEASE 2020; 9:327-334. [PMID: 30958313 DOI: 10.3233/jpd-181517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND In patients with early parkinsonism, misdiagnosis may occur in >30% of cases. This can have detrimental consequences clinically and in clinical trials. Dopamine transporter (DAT) SPECT imaging can help improve diagnostic accuracy. OBJECTIVE To describe characteristics of individuals initially diagnosed with idiopathic Parkinson's disease (iPD) and with abnormal DAT SPECT imaging who had a change in diagnosis on follow-up. METHODS Data were obtained from the biomarker study Parkinson's Progression Markers Initiative (PPMI). PPMI is a multicenter, observational study that enrolled 423 individuals with a diagnosis of iPD of ≤2 years duration and with abnormal DAT SPECT imaging. Participants were assessed at least annually, and diagnosis was documented by the site neurologist. Characteristics of those that had a change in diagnosis were compared to those with stable diagnosis. RESULTS 390 subjects were included. Eight (2%) had a change in diagnosis. The diagnosis was changed to multiple system atrophy in 5 cases, dementia with Lewy bodies in 2, and corticobasal degeneration in 1. Revision of diagnosis occurred 2-5.2 years from enrollment. Mean motor score was higher (26.9 vs 20.6; p = 0.01), DAT binding lower (1.056 vs 1.406; p = 0.01), genetic risk score lower (-0.016 vs -0.022; p = 0.0470), and olfaction score higher (28.75 vs 22.05; p = 0.03) in those whose diagnosis changed compared to those who did not. CONCLUSION Diagnosis remained stable in most individuals with early parkinsonism diagnosed with iPD and with abnormal DAT imaging. A small number had a revision in diagnosis. Clinical and biomarker abnormalities were greater at baseline in those whose diagnosis changed.
Collapse
Affiliation(s)
- Jason Massa
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lana M Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
5
|
Iranzo A, Stefani A, Niñerola-Baizan A, Stokner H, Serradell M, Vilas D, Holzknecht E, Gaig C, Pavia J, Lomeña F, Reyes D, Seppi K, Santamaria J, Högl B, Tolosa E, Poewe W. Left-hemispheric predominance of nigrostriatal deficit in isolated REM sleep behavior disorder. Neurology 2020; 94:e1605-e1613. [DOI: 10.1212/wnl.0000000000009246] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 10/17/2019] [Indexed: 01/01/2023] Open
Abstract
ObjectiveUnilateral onset of parkinsonism due to nigrostriatal damage of the contralateral hemisphere is frequent in Parkinson disease (PD). There is evidence for a left-hemispheric bias of motor asymmetry in right-handed patients with PD indicating a hemispheric dominance. Isolated REM sleep behavior disorder (IRBD) constitutes the prodromal stage of PD and other synucleinopathies. To test the hypothesis that right-handed patients with IRBD exhibit left-hemispheric predominance of subclinical nigrostriatal dysfunction, we evaluated this aspect using neuroimaging instruments.MethodsIn 167 right-handed patients with IRBD without parkinsonism, we evaluated in each hemisphere the integrity of the striatal dopaminergic terminals by dopamine transporter (DAT)-SPECT and the substantia nigra echogenicity by transcranial sonography.ResultsDAT-SPECT showed lower specific binding ratio (SBR) in the left striatum and left caudate nucleus than in the right striatum and right caudate nucleus. The percentage of patients with lower SBR was greater in the left striatum and left caudate nucleus than in the right striatum and right caudate nucleus. In those who developed a synucleinopathy in <5 years from DAT-SPECT, there was a lower SBR in the left putamen and left caudate nucleus than in the right putamen and right caudate nucleus. Substantia nigra echogenic size was greater in the left than in the right side in patients with hyperechogenicity and among individuals who phenoconverted in <5 years from transcranial sonography.ConclusionRight-handed patients with IRBD exhibit left-hemispheric predominance of subclinical nigrostriatal dysfunction. In premotor PD, the neurodegenerative process begins asymmetrically, initially impairing the nigrostriatal system of the dominant hemisphere.
Collapse
|
6
|
Riederer P, Jellinger KA, Kolber P, Hipp G, Sian-Hülsmann J, Krüger R. Lateralisation in Parkinson disease. Cell Tissue Res 2018; 373:297-312. [PMID: 29656343 DOI: 10.1007/s00441-018-2832-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/21/2018] [Indexed: 01/11/2023]
Abstract
Asymmetry of dopaminergic neurodegeneration and subsequent lateralisation of motor symptoms are distinctive features of Parkinson's disease compared to other forms of neurodegenerative or symptomatic parkinsonism. Even 200 years after the first description of the disease, the underlying causes for this striking clinicopathological feature are not yet fully understood. There is increasing evidence that lateralisation of disease is due to a complex interplay of hereditary and environmental factors that are reflected not only in the concept of dominant hemispheres and handedness but also in specific susceptibilities of neuronal subpopulations within the substantia nigra. As a consequence, not only the obvious lateralisation of motor symptoms occurs but also patterns of associated non-motor signs are defined, which include cognitive functions, sleep behaviour or olfaction. Better understanding of the mechanisms contributing to lateralisation of neurodegeneration and the resulting patterns of clinical phenotypes based on bilateral post-mortem brain analyses and clinical studies focusing on right/left hemispheric symptom origin will help to develop more targeted therapeutic approaches, taking into account subtypes of PD as a heterogeneous disorder.
Collapse
Affiliation(s)
- P Riederer
- Center of Mental Health, Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany. .,Psychiatry Department of Clinical Research, University of Southern Denmark, Odense University Hospital, J.B. Winsløws Vej 18, Indgang 220 A, DK-5000, Odense C, Denmark.
| | - K A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150, Vienna, Austria
| | - P Kolber
- Parkinson Research Clinic, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - G Hipp
- Parkinson Research Clinic, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - J Sian-Hülsmann
- Department of Medical Physiology, University of Nairobi, PO Box 30197, Nairobi, 00100, Kenya
| | - R Krüger
- Parkinson Research Clinic, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| |
Collapse
|
7
|
Is Parkinson's Disease with History of Agent Orange Exposure Different from Idiopathic Parkinson's Disease? Dement Neurocogn Disord 2016; 15:75-81. [PMID: 30906346 PMCID: PMC6427963 DOI: 10.12779/dnd.2016.15.3.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose During Vietnam War, many Korean soldiers were dispatched to fight in the war where they were exposed to Agent Orange. Until now, there exist only limited evidence on existence of association between exposure to Agent Orange and Parkinson's disease (PD). To elucidate the effects of Agent Orange exposure on PD, we compared the clinical characteristics and radiolabeled 18F-FP-CIT PET uptake between patients with Agent Orange exposure and patients with Agent Orange no-exposure. Methods We retrospectively evaluated 143 patients exposed to Agent Orange and 500 patients with no exposure to Agent Orange from our movement clinics database. The differences between clinical characteristics and pattern of 18F-FP-CIT PET uptake were investigated. Results Among Unified Parkinson's Disease Rating Scale III motor subscales, tremor at rest, rigidity, finger taps, and rapid alternating movement was significantly higher in patients exposed to Agent Orange as compared to patients with no exposure to Agent Orange. The facial expression score was significantly lower in patients exposed to Agent Orange as compared to patients with no exposure to Agent Orange. Compared to patients not exposed to Agent Orange, all basal ganglia areas (contra- and ipsilateral caudate nucleus, anterior putamen, and posterior putamen) showed a lower18F-FP-CIT uptake and higher asymmetry index of anterior and posterior putamen was found in patients exposed to Agent Orange. The caudate/putamen ratio was significantly lower in patients exposed to Agent Orange as compared to patients with no exposure to Agent Orange. Conclusions This study showed a different clinical profile and FP-CIT PET findings between patients exposed to Agent Orange as compared to patients with no exposure to Agent Orange. This finding suggests the possibility of different pathophysiology of PD in patients exposed to Agent Orange from idiopathic PD.
Collapse
|
8
|
Iosa M, Morone G, Fusco A, Marchetti F, Caltagirone C, Paolucci S, Peppe A. Loss of fractal gait harmony in Parkinson's Disease. Clin Neurophysiol 2015; 127:1540-1546. [PMID: 26679417 DOI: 10.1016/j.clinph.2015.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/21/2015] [Accepted: 11/21/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Recently, an intrinsic fractal harmonic structure was found underlying the rhythm of physiological walking, but it has not yet been investigated in subjects with a neurological disease. The aim of this study was to determine if and how this harmonic structure is altered in patients with Parkinson's Disease. METHODS Gait analysis of 70 patients with Parkinson's Disease in pharmacological phase on was performed, the findings of which we compared with reference data of age-matched healthy subjects. Fifteen patients were retested after a washout period of 12 h. RESULTS Alterations in all spatio-temporal gait parameters and gait indices with regard to symmetry, coordination, and harmony were noted, but after correction for multicollinearity bias, only the latter correlated significantly with Unified Parkinson's Disease Rating Scale motor score (p=0.001). The fractal gait structure underwent even more extensive alterations in pharmacological off phase (p<0.05). CONCLUSIONS The intrinsic gait harmony was altered in patients with Parkinson's Disease and significantly correlated to motor severity. It could be partially recovered by assumption of L-dopa. SIGNIFICANCE Loss of harmony is a quantitatively assessable gait benchmark in Parkinson's Disease. It seems to be dependent on dopaminergic but also on non-dopaminergic networks.
Collapse
Affiliation(s)
- Marco Iosa
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy.
| | - Giovanni Morone
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy
| | - Augusto Fusco
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy
| | - Fabio Marchetti
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy
| | - Carlo Caltagirone
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy; Tor Vergata University of Rome, via Montpellier 1, 00133 Rome, Italy
| | - Stefano Paolucci
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy
| | - Antonella Peppe
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy
| |
Collapse
|
9
|
Hwang I, Sohn CH, Kang KM, Jeon BS, Kim HJ, Choi SH, Yun TJ, Kim JH. Differentiation of Parkinsonism-Predominant Multiple System Atrophy from Idiopathic Parkinson Disease Using 3T Susceptibility-Weighted MR Imaging, Focusing on Putaminal Change and Lesion Asymmetry. AJNR Am J Neuroradiol 2015; 36:2227-34. [PMID: 26338919 DOI: 10.3174/ajnr.a4442] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 04/23/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Asymmetric presentation of clinical feature in parkinsonism is common, but correlatable radiologic feature is not clearly defined. Our aim was to evaluate 3T susceptibility-weighted imaging findings for differentiating parkinsonism-predominant multiple system atrophy from idiopathic Parkinson disease, focusing on putaminal changes and lesion asymmetry. MATERIALS AND METHODS This retrospective cohort study included 27 patients with parkinsonism-predominant multiple system atrophy and 50 patients with idiopathic Parkinson disease diagnosed clinically. Twenty-seven age-matched subjects without evidence of movement disorders who underwent SWI were included as the control group. A consensus was reached by 2 radiologists who visually assessed SWI for the presence of putaminal atrophy and marked signal hypointensity on each side of the posterolateral putamen. We also quantitatively measured putaminal width and phase-shift values. RESULTS The mean disease duration was 4.7 years for the patients with parkinsonism-predominant multiple system atrophy and 7.8 years for the patients with idiopathic Parkinson disease. In the patients with parkinsonism-predominant multiple system atrophy, putaminal atrophy was frequently observed (14/27, 51.9%) and was most commonly found in the unilateral putamen (13/14). Marked signal hypointensity was observed in 12 patients with parkinsonism-predominant multiple system atrophy (44.4%). No patients with idiopathic Parkinson disease or healthy controls showed putaminal atrophy or marked signal hypointensity. Quantitatively measured putaminal width, phase-shift values, and the ratio of mean phase-shift values for the dominant and nondominant sides were significantly different between the parkinsonism-predominant multiple system atrophy group and the idiopathic Parkinson disease and healthy control groups (P < .001). CONCLUSIONS 3T SWI can visualize putaminal atrophy and marked signal hypointensity in patients with parkinsonism-predominant multiple system atrophy with high specificity. Furthermore, it clearly demonstrates the dominant side of putaminal changes, which correlate with the contralateral symptomatic side of patients.
Collapse
Affiliation(s)
- I Hwang
- From the Departments of Radiology (I.H., C.-H.S., K.M.K, S.H.C., T.J.Y., J.-h.K.)
| | - C-H Sohn
- From the Departments of Radiology (I.H., C.-H.S., K.M.K, S.H.C., T.J.Y., J.-h.K.) Department of Radiology (C.-H.S.), Seoul National University College of Medicine, Seoul, Korea Institute of Radiation Medicine (C.-H.S.), Seoul National University Medical Research Center, Seoul, Korea.
| | - K M Kang
- From the Departments of Radiology (I.H., C.-H.S., K.M.K, S.H.C., T.J.Y., J.-h.K.)
| | - B S Jeon
- Neurology (B.S.J., H.-J.K.), Seoul National University Hospital, Seoul, Korea
| | - H-J Kim
- Neurology (B.S.J., H.-J.K.), Seoul National University Hospital, Seoul, Korea
| | - S H Choi
- From the Departments of Radiology (I.H., C.-H.S., K.M.K, S.H.C., T.J.Y., J.-h.K.)
| | - T J Yun
- From the Departments of Radiology (I.H., C.-H.S., K.M.K, S.H.C., T.J.Y., J.-h.K.)
| | - J-H Kim
- From the Departments of Radiology (I.H., C.-H.S., K.M.K, S.H.C., T.J.Y., J.-h.K.)
| |
Collapse
|
10
|
Marinus J, van Hilten JJ. The significance of motor (A)symmetry in Parkinson's disease. Mov Disord 2014; 30:379-85. [DOI: 10.1002/mds.26107] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 10/27/2014] [Accepted: 11/05/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Johan Marinus
- Department of NeurologyLeiden University Medical CenterLeiden The Netherlands
| | | |
Collapse
|
11
|
Jaywant A, Musto G, Neargarder S, Stavitsky Gilbert K, Cronin-Golomb A. The effect of Parkinson's disease subgroups on verbal and nonverbal fluency. J Clin Exp Neuropsychol 2014; 36:278-89. [PMID: 24533593 DOI: 10.1080/13803395.2014.889089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Parkinson's disease (PD) leads to deficits in executive function, including verbal and nonverbal fluency, as a result of compromised frontostriatal circuits. It is unknown whether deficits in verbal and nonverbal fluency in PD are driven by certain subgroups of patients, or how strategy use may facilitate performance. PARTICIPANTS Sixty-five nondemented individuals with PD, including 36 with right-body onset (RPD; 20 with tremor as their initial symptom, 16 nontremor) and 29 with left-body onset (LPD; 14 with tremor as their initial symptom, 15 nontremor), and 52 normal control participants (NC) took part in the study. MEASUREMENTS Verbal fluency was assessed using the FAS and Animals tests. Nonverbal fluency was assessed using the Ruff Figural Fluency Test. RESULTS Both RPD and LPD were impaired in generating words and in using clustering and switching strategies on phonemic verbal fluency, whereas different patterns of impairment were found on nonverbal fluency depending on the interaction of side of onset and initial motor symptom (tremor vs. nontremor). Strategy use correlated with number of correct responses on verbal fluency in LPD, RPD, and NC. By contrast, on nonverbal fluency, strategy use correlated with correct responses for RPD and LPD, but not for NC. CONCLUSION Our findings demonstrate the importance of considering subgroups in PD and analyzing subcomponents of verbal and nonverbal fluency (correct responses, errors, and strategies), which may depend differently on the integrity of dorsolateral prefrontal cortex, inferior frontal cortex, and anterior cingulate cortex.
Collapse
Affiliation(s)
- Abhishek Jaywant
- a Department of Psychological and Brain Sciences , Boston University , Boston , MA , USA
| | | | | | | | | |
Collapse
|
12
|
The influence of age and gender on motor and non-motor features of early Parkinson's disease: Initial findings from the Oxford Parkinson Disease Center (OPDC) discovery cohort. Parkinsonism Relat Disord 2014; 20:99-105. [DOI: 10.1016/j.parkreldis.2013.09.025] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/26/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
|
13
|
Poewe W, Mahlknecht P. Combined assessment of midbrain hyperechogenicity, hyposmia and motor asymmetry improves diagnostic accuracy in early Parkinson's disease. Expert Rev Neurother 2013; 12:911-4. [PMID: 23002935 DOI: 10.1586/ern.12.75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The differential diagnosis of Parkinsonian syndromes can be challenging, particularly in early disease stages, when overlapping clinical signs and symptoms may lead to erroneous classification. However, an early differentiation between Parkinson's disease (PD) and other diseases causing Parkinsonism is crucial for prognostic and therapeutic reasons and is essential for clinical research. In a recent study, Busse et al. investigated the diagnostic utility of a set of tests to improve diagnostic differentiation between PD, essential tremor and other Parkinsonian disorders. The authors studied a total of 632 patients divided into a retrospective (n = 517) and a prospective (n = 115) group. Diagnostic anchors were based on clinical criteria. Combining midbrain hyperechogenicity, hyposmia and motor asymmetry increased specificity and positive predictive value for diagnosis of PD up to 98% at the expense of sensitivity, whereas two features provided 91% sensitivity with 77% specificity. The results of this study further support the diagnostic utility of transcranial sonography in diagnosing PD.
Collapse
Affiliation(s)
- Werner Poewe
- Department of Neurology, University of Innsbruck, A-6020 Innsbruck, Anichstrasse 35, Austria.
| | | |
Collapse
|
14
|
Margariti PN, Astrakas LG, Tsouli SG, Hadjigeorgiou GM, Konitsiotis S, Argyropoulou MI. Investigation of unmedicated early onset restless legs syndrome by voxel-based morphometry, T2 relaxometry, and functional MR imaging during the night-time hours. AJNR Am J Neuroradiol 2011; 33:667-72. [PMID: 22173758 DOI: 10.3174/ajnr.a2829] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE The pathophysiology of eRLS has not yet been elucidated. The purpose of the study was to assess, in patients with eRLS, the volume, iron content, and activation of the brain during night-time episodes of SLD and PLMs. MATERIALS AND METHODS Eleven right-handed unmedicated patients with eRLS (mean age, 55.3 ± 8.4 years; disease duration, 17.5 ± 14.05 years) and 11 matched control subjects were studied with a T1-weighted high-resolution 3D spoiled gradient-echo sequence used for VBM and a multisection spin-echo T2-weighted sequence used for T2 relaxometry. Additionally, a single-shot multisection gradient echo-planar sequence was used for fMRI. Brain activation was recorded during spontaneous SLD and PLMs. SPM software was used for analysis of the functional data. RESULTS The patients showed no regional brain volume change, but T2 relaxometry revealed decreased T2 relaxation time in the right globus pallidus internal and the STN, indicating increased iron content. The patients were observed to activate the following areas: in the left hemisphere, the primary motor and somatosensory cortex, the thalamus, the pars opercularis, and the ventral anterior cingulum; and in the right hemisphere, the striatum, the inferior and superior parietal lobules, and the dorsolateral prefrontal cortex. Bilateral activation was observed in the cerebellum, the midbrain, and the pons. CONCLUSIONS eRLS is associated with increased iron content of the globus pallidus internal and STN, suggesting dysfunction of the basal ganglia. Activation of the striatofrontolimbic area may represent the neurofunctional substrate mediating the repetitive compulsive movements seen in RLS.
Collapse
Affiliation(s)
- P N Margariti
- Department of Radiology, Medical School, University of Ioannina, Ioannina, Greece
| | | | | | | | | | | |
Collapse
|
15
|
Asymmetry in parkinsonism, spreading pathogens and the nose. Parkinsonism Relat Disord 2011; 18:1-9. [PMID: 21752693 DOI: 10.1016/j.parkreldis.2011.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 06/17/2011] [Accepted: 06/18/2011] [Indexed: 11/20/2022]
Abstract
Parkinson's disease, as well as many other parkinsonisms, including most toxic, neurodegenerative and familial types are typically asymmetric. No explanation for this phenomenon exists. A summary of the frequency of asymmetry in a spectrum of parkinsonian disorders is provided. Evidence against asymmetry being the result of normal asymmetries of the substantia nigrais reviewed. Asymmetry either results from a greater susceptibility on one side or a spreading pathology entering or starting on one side of the CNS. With the increasing evidence for spreading pathologies (toxins, viruses, α-synuclein), knowledge of neuroanatomical connections, and literature implicating spreading pathogens from the enteric and olfactory nerves, potential explanations can be theorized and explored, including the possibility of a pathogen preferentially entering or originating in the olfactory bulb on one side, with subsequent involvement of the other side.
Collapse
|