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Liu Y, Chang D, Zhou X. Development of Novel Herbal Compound Formulations Targeting Neuroinflammation: Network Pharmacology, Molecular Docking, and Experimental Verification. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:2558415. [PMID: 37266321 PMCID: PMC10232107 DOI: 10.1155/2023/2558415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/05/2023] [Accepted: 04/20/2023] [Indexed: 06/03/2023]
Abstract
Neuroinflammation plays an important role in the onset and progression of neurodegenerative diseases. The multicomponent and multitarget approach may provide a practical strategy to address the complex pathological mechanisms of neuroinflammation. This study aimed to develop synergistic herbal compound formulas to attenuate neuroinflammation using integrated network pharmacology, molecular docking, and experimental bioassays. Eight phytochemicals with anti-neuroinflammatory potential were selected in the present study. A compound-gene target-signaling pathway network was constructed to illustrate the mechanisms of action of each phytochemical and the interactions among them at the molecular level. Molecular docking was performed to verify the binding affinity of each phytochemical and its key gene targets. An experimental study was conducted to identify synergistic interactions among the eight phytochemicals, and the associated molecular mechanisms were examined by immunoblotting based on the findings from the network pharmacology analysis. Two paired combinations, andrographolide and 6-shogaol (AN-SG) (IC50 = 2.85 μg/mL), and baicalein-6-shogaol (BA-SG) (IC50 = 3.28 μg/mL), were found to synergistically (combination index <1) inhibit the lipopolysaccharides (LPS)-induced nitric oxide production in microglia N11 cells. Network pharmacology analysis suggested that MAPK14, MAPK8, and NOS3 were the top three relevant gene targets for the three phytochemicals, and molecular docking demonstrated strong binding affinities of the phytochemicals to their coded proteins. Immunoblotting suggested that the AN-SG and BA-SG both showed prominent effects in inhibiting inducible nitric oxide synthase (iNOS) (p < 0.01 and p < 0.05, respectively) and MAPKp-p38 (both p < 0.05) compared with those induced by the LPS stimulation only. The AN-SG combination exhibited greater inhibitions of the protein expressions of iNOS (p < 0.05 vs. individual components), which may partly explain the mechanisms of the synergy observed. This study established a practical approach to developing novel herbal-compound formulations using integrated network pharmacology analysis, molecular docking, and experimental bioassays. The study provides a scientific basis and new insight into the two synergistic combinations against neuroinflammation.
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Affiliation(s)
- Yang Liu
- NICM Health Research Institute, Western Sydney University, Westmead, NSW 2145, Australia
| | - Dennis Chang
- NICM Health Research Institute, Western Sydney University, Westmead, NSW 2145, Australia
| | - Xian Zhou
- NICM Health Research Institute, Western Sydney University, Westmead, NSW 2145, Australia
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Liu Y, Chang D, Liu T, Zhou X. Natural product-based bioactive agents in combination attenuate neuroinflammation in a tri-culture model. Front Pharmacol 2023; 14:1135934. [PMID: 36873986 PMCID: PMC9979791 DOI: 10.3389/fphar.2023.1135934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction: Neuroinflammation is an important pathological event contributing to the onset and progression of neurodegenerative diseases. The hyperactivation of microglia triggers the release of excessive proinflammatory mediators that lead to the leaky blood-brain barrier and impaired neuronal survival. Andrographolide (AN), baicalein (BA) and 6-shogaol (6-SG) possess anti-neuroinflammatory properties through diverse mechanisms of action. The present study aims to investigate the effects of the pair-combinations of these bioactive compounds in attenuating neuroinflammation. Methods: A tri-culture model with microglial N11 cells, microvascular endothelial MVEC(B3) cells, and neuroblastoma N2A cells was established in a transwell system. AN, BA and 6-SG used alone (25 µM) or in pair-wised combinations (12.5 + 12.5 µM) were subjected to the tri-culture system. Upon the stimulation of lipopolysaccharides (LPS) at 1 μg/mL, tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) levels were determined by ELISA assays. Immunofluorescence staining was applied to investigate the nuclear translocation of nuclear factor kappa B p65 (NF-κB p65) on N11 cells, expressions of protein zonula occludens-1 (ZO-1) on MVEC cells and phosphorylated tau (p-tau) on N2A cells, respectively. The endothelial barrier permeability of MVEC cells was assessed by the Evans blue dye, and the resistance from the endothelial barrier was measured by transepithelial/endothelial electrical resistance (TEER) value. Neuronal survival of N2A cells was determined by Alamar blue and MTT assays. Results: Combinations of AN-SG and BA-SG synergistically lowered the TNF and IL-6 levels in LPS-induced N11 cells. Remarkably, the combined anti-neuroinflammatory effects of AN-SG and BA-SG remained significantly greater compared to their individual components at the same concentration level. The molecular mechanism of the attenuated neuroinflammation was likely to be mediated by downregulation of NF-κB p65 translocation (p < 0.0001 vs. LPS stimulation) in N11 cells. In the MVEC cells, both AN-SG and BA-SG restored TEER values, ZO-1 expression and reduced permeability. Furthermore, AN-SG and BA-SG significantly improved neuronal survival and reduced expressions of p-tau on N2A cells. Discussion: The AN-SG and BA-SG combinations showed greater anti-neuroinflammatory potential than those used alone in mono- and tri-cultured N11 cells, thereby further protecting endothelial tight junction and neuronal survival. Taken together, AN-SG and BA-SG may provide improved anti-neuroinflammatory and neuroprotective activities.
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Affiliation(s)
- Yang Liu
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Dennis Chang
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Tianqing Liu
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia.,School of Science, Western Sydney University, Penrith, NSW, Australia
| | - Xian Zhou
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
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Cohen SR, Terry ML, Coyle M, Wheelis E, Centner A, Smith S, Glinski J, Lipari N, Budrow C, Manfredsson FP, Bishop C. The multimodal serotonin compound Vilazodone alone, but not combined with the glutamate antagonist Amantadine, reduces l-DOPA-induced dyskinesia in hemiparkinsonian rats. Pharmacol Biochem Behav 2022; 217:173393. [DOI: 10.1016/j.pbb.2022.173393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 01/06/2023]
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Sawada H, Oeda T, Kohsaka M, Tomita S, Umemura A, Park K, Yamamoto K, Kiyohara K. Early-start vs delayed-start donepezil against cognitive decline in Parkinson disease: a randomized clinical trial. Expert Opin Pharmacother 2020; 22:363-371. [PMID: 32867552 DOI: 10.1080/14656566.2020.1814255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cholinergic neurotransmission regulates neuroinflammation in Parkinson disease (PD). RESEARCH DESIGN AND METHODS The authors conducted a delayed-start study of donepezil for cognitive decline in non-demented PD patients. The study consisted of a 96-week randomized placebo-controlled double-blind phase 1, followed by a 24-week donepezil extension phase 2. The primary outcome measure was a change in the Mini-Mental State Examination (MMSE) at week 120. RESULTS A total of 98 patients were randomly allocated to the early-start (donepezil-to-donepezil) and delayed-start (placebo-to-donepezil) groups. Mean (SD) of the baseline MMSE was 27.6 (2.0) and 28.0 (2.1), respectively. MMSE change at week 120 was better in the early-start group than in the delayed-start group, but the difference was not significant. The MMSE declined in apolipoprotein ε4 carriers, but not in non-carriers, and the factor interaction (intervention × ε4 genotype) was highly significant (P < 0.001). Analyzed with the interaction, the difference was significant (group difference 1.95 [0.33 to 3.57], P = 0.018). The MMSE decline slope in phase 1 was significantly better in the early-start group than in the delayed-start group (P = 0.048). CONCLUSIONS Cognitive function deteriorated in ε4 carriers, but not in non-carriers, and early-start donepezil may postpone cognitive decline in the former.
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Affiliation(s)
- Hideyuki Sawada
- Department of Neurology, Utano National Hospital, National Hospital Organization , Kyoto, Japan
| | - Tomoko Oeda
- Department of Neurology, Utano National Hospital, National Hospital Organization , Kyoto, Japan
| | - Masayuki Kohsaka
- Department of Neurology, Utano National Hospital, National Hospital Organization , Kyoto, Japan
| | - Satoshi Tomita
- Department of Neurology, Utano National Hospital, National Hospital Organization , Kyoto, Japan
| | - Atsushi Umemura
- Department of Neurology, Utano National Hospital, National Hospital Organization , Kyoto, Japan
| | - Kwiyoung Park
- Department of Neurology, Utano National Hospital, National Hospital Organization , Kyoto, Japan
| | - Kenji Yamamoto
- Department of Neurology, Utano National Hospital, National Hospital Organization , Kyoto, Japan
| | - Kosuke Kiyohara
- Department of Public Health, Tokyo Women's Medical University , Tokyo, Japan
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Battisto J, Echt KV, Wolf SL, Weiss P, Hackney ME. The Body Position Spatial Task, a Test of Whole-Body Spatial Cognition: Comparison Between Adults With and Without Parkinson Disease. Neurorehabil Neural Repair 2018; 32:961-975. [PMID: 30317924 PMCID: PMC6226349 DOI: 10.1177/1545968318804419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Body Position Spatial Task (BPST) is a novel measure of whole-body spatial cognition involving multidirectional steps and turns. Individuals with Parkinson disease (PD) are affected by motor and cognitive impairments, particularly in spatial function, which is important for mental imagery and navigation. Performance on the BPST may inform understanding of motor-cognitive and spatial cognitive function of individuals with PD. OBJECTIVES We conducted this study to determine feasibility and validity of the BPST with standard, validated, and reliable measures of spatial cognition and motor-cognitive integration and to compare BPST performance in adults with and without PD. METHODS A total of 91 individuals with mild-moderate PD and 112 neurotypical (NT) adults of similar age were recruited for the study to complete the BPST and other measures of mobility and cognition. Correlations were used to determine construct and concurrent validity of BPST with valid measures of spatial cognition and motor-cognitive integration. Performance was compared between PD and NT adults using independent t-tests. RESULTS BPST was feasible to administer. Analyses show evidence of construct validity for spatial cognition and for motor-cognitive integration. Concurrent validity was demonstrated with other tests of mobility and cognition. Relationships were stronger and more significant for individuals with PD than for NT individuals. BPST performance was not significantly different between groups. CONCLUSION Tests that integrate cognitive challenge in mobility contexts are necessary to assess the health of spatial cognitive and motor-cognitive integration. The BPST is a feasible and valid test of whole-body spatial cognition and motor-cognitive integration in individuals with PD.
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Affiliation(s)
| | - Katharina V. Echt
- Atlanta Veterans Affairs Medical Center, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
- Geriatric Research, Education, and Clinical Center (GRECC), Birmingham/Atlanta Veterans Affairs Medical Centers
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Steven L. Wolf
- Atlanta Veterans Affairs Medical Center, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
- Emory University Department of Rehabilitation Medicine, Division of Physical Therapy
| | - Paul Weiss
- Atlanta Veterans Affairs Medical Center, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
- Rollins School of Public Health, Emory University
| | - Madeleine E. Hackney
- Atlanta Veterans Affairs Medical Center, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
- Geriatric Research, Education, and Clinical Center (GRECC), Birmingham/Atlanta Veterans Affairs Medical Centers
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
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Goedeken S, Potempa C, Prager EM, Foster ER. Encoding strategy training and self-reported everyday prospective memory in people with Parkinson disease: a randomized-controlled trial. Clin Neuropsychol 2017; 32:1282-1302. [PMID: 29029571 DOI: 10.1080/13854046.2017.1387287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective To compare the effects of laboratory-based training in implementation intentions (II; experimental strategy) and verbal rehearsal (VR; control strategy) on self-reported everyday prospective memory among people with Parkinson disease (PD) and to investigate potential correlates of change in self-reported everyday prospective memory in response to this training. Method This was a randomized-controlled trial. Participants with mild to moderate PD without dementia underwent one session of training in either II (n = 25) or VR (n = 27). Then they were instructed to use their strategy as much as possible in their everyday lives to help them remember to do things. The Prospective and Retrospective Memory Questionnaire Prospective Scale (PRMQ-Pro) administered at baseline and one month after training assessed training-related change in self-reported everyday prospective memory. Baseline depressive symptoms, perceptions of the strategy (credibility, expectancy), prospective memory-related awareness, global cognition, and disease severity were correlated to PRMQ-Pro Change scores (post minus pre) to determine their association with response to training. Results The VR group's PRMQ-Pro scores declined from pre to post training, while the II group's remained stable (p = .03). This effect was driven by change in self-cued everyday prospective memory tasks. Higher baseline depressive symptoms, treatment expectancy, and global cognition related to better response to training in the II group (rs ≤ -.40, ps ≤ .05). Conclusions II training may prevent everyday prospective memory decline among people with PD. In addition, people with higher depression, stronger expectations of improvement from strategy training, or better global cognition may benefit the most from II training.
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Affiliation(s)
- Susan Goedeken
- a Program in Occupational Therapy , Washington University School of Medicine , St. Louis , MO , USA
| | - Cathryne Potempa
- a Program in Occupational Therapy , Washington University School of Medicine , St. Louis , MO , USA
| | - Eliza M Prager
- b Occupational Therapy Program , Maryville University College of Health Professions , St. Louis , MO , USA
| | - Erin R Foster
- a Program in Occupational Therapy , Washington University School of Medicine , St. Louis , MO , USA.,c Department of Neurology , Washington University School of Medicine , St. Louis , MO , USA.,d Department of Psychiatry , Washington University School of Medicine , St. Louis, MO , USA
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Zhang XY, Tan YL, Chen DC, Tan SP, Yang FD, Zunta-Soares GB, Soares JC. Effects of cigarette smoking and alcohol use on neurocognition and BDNF levels in a Chinese population. Psychopharmacology (Berl) 2016; 233:435-45. [PMID: 26518023 DOI: 10.1007/s00213-015-4124-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 10/13/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Few studies have examined the potential interactive effect of both smoking and drinking on cognition. Brain-derived neurotrophic factor (BDNF) plays a critical role in cognition. This is the first study to examine the neurocognitive consequences of cigarette smoking combined with chronic alcohol consumption and their relationship to serum BDNF levels in a Chinese Han population. MATERIALS AND METHODS We recruited 191 healthy male subjects, including 47 isolated smokers, 31 isolated chronic alcohol users, 58 combined smokers and chronic alcohol users, and 55 non-smokers and non-alcohol users. We then compared the repeatable battery for the assessment of neuropsychological status (RBANS) scores and serum BDNF levels in these four groups. RESULTS When compared to the non-smoking + non-alcohol-using group, the smoking group performed worse on immediate memory, attention, language, and RBANS total score. There were no significant differences in the RBANS scores between the alcohol-using group and non-smoking + non-alcohol-using group, or between the smoking group and smoking + alcohol-using group. We did not find an association between BDNF and smoking or drinking status or between BDNF and cognitive performance. In the smoking group, there was a significant correlation between BDNF and carbon monoxide concentration, and between BDNF and the Fagerstrom Test for Nicotine Dependence (FTND) total score. CONCLUSIONS Our results suggest that smoking is associated with cognitive decline, but not with BDNF levels in a normal population. However, smoking severity is positively associated with BDNF levels. Concomitant alcohol use does not worsen the cognitive decline caused by smoking.
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Affiliation(s)
- Xiang Yang Zhang
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China.
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.
- UT Center of Excellence on Mood Disorders (UTCEMD), Biomedical and Behavioral Sciences Building, 1941 East Road, Houston, TX, 77054, USA.
| | - Yun-Long Tan
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Da-Chun Chen
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Shu-Ping Tan
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Fu-De Yang
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Giovana B Zunta-Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Sawada H, Oeda T, Umemura A, Tomita S, Hayashi R, Kohsaka M, Yamamoto K, Sudoh S, Sugiyama H. Subclinical elevation of plasma C-reactive protein and illusions/hallucinations in subjects with Parkinson's disease: case-control study. PLoS One 2014; 9:e85886. [PMID: 24497930 PMCID: PMC3908859 DOI: 10.1371/journal.pone.0085886] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/03/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Though infections are associated with psychotic symptoms, whether or not subclinical inflammation is associated with hallucinations is not known in Parkinson's disease (PD). PURPOSE To investigate the association of illusions/hallucinations and plasma CRP levels in PD patients without symptomatic infections. METHODS PD patients not diagnosed as having infections were assessed for illusions and hallucinations using the Parkinson Psychosis Questionnaire (PPQ). It comprises four-domain questions: PPQ-A for sleep problems, PPQ-B for hallucinations/illusions, PPQ-C for delusions, and PPQ-D for disorientation. Assigning patients with ≥1 points in the PPQ-B score to be cases and others as controls, the association of hallucinations/illusions and clinical features (age, sex, duration of PD, Unified Parkinson's Disease Rating Scale part 3 (UPDRS-3), Mini-Mental State Examination (MMSE) score, sleep disturbance (PPQ-A score) as well as daily doses of L-Dopa, dopamine agonists, amantadine, and selegiline) were analyzed using a case-control design. RESULTS A total of 111 patients were examined and plasma CRP levels were <0.1-6.0 mg/L. Hallucinations or illusions were detected in 28 (25.2%). There were significant differences in age, UPDRS-3 score, MMSE score, PPQ-A, daily doses of L-Dopa and dopamine agonists and plasma CRP levels between cases and controls. A multivariate logistic regression model revealed that UPDRS-3 scores and plasma CRP levels were significantly associated with hallucinations/illusions with an adjusted odds ratio of 1.96 (95% confidence interval (CI) 1.20-3.20) per 10 points and 1.57 (95% confidence interval 1.13-2.16) per two-fold, respectively. Dividing patients into thirds by CRP levels (≤0.2, 0.3-0.6, ≥0.7 mg/L), the prevalence of hallucinations/illusions was 13.2%, 21.6%, and 41.7%, in the bottom-, middle-, and top-thirds, respectively (for trend p = 0.012). CONCLUSIONS Subclinical elevation of plasma CRP levels was associated with hallucinations or illusions after adjustment for motor disability, suggesting that subclinical elevations of CRP levels might be an independent risk for hallucinations/illusions.
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Affiliation(s)
- Hideyuki Sawada
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Tomoko Oeda
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Atsushi Umemura
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Satoshi Tomita
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Ryutaro Hayashi
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Masayuki Kohsaka
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Kenji Yamamoto
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Shinji Sudoh
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
| | - Hiroshi Sugiyama
- Clinical Research Center and Department of Neurology, National Hospital of Utano, Kyoto, Japan
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Larner AJ. Cholinesterase inhibitors: beyond Alzheimer’s disease. Expert Rev Neurother 2014; 10:1699-705. [DOI: 10.1586/ern.10.105] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Almeida QJ, Brown MJN. Is DOPA-Responsive Hypokinesia Responsible for Bimanual Coordination Deficits in Parkinson's Disease? Front Neurol 2013; 4:89. [PMID: 23882254 PMCID: PMC3715734 DOI: 10.3389/fneur.2013.00089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 06/25/2013] [Indexed: 11/21/2022] Open
Abstract
Bradykinesia is a well-documented DOPA-responsive clinical feature of Parkinson’s disease (PD). While amplitude deficits (hypokinesia) are a key component of this slowness, it is important to consider how dopamine influences both the amplitude (hypokinesia) and frequency components of bradykinesia when a bimanually coordinated movement is required. Based on the notion that the basal ganglia are associated with sensory deficits, the influence of dopaminergic replacement on sensory feedback conditions during bimanual coordination was also evaluated. Bimanual movements were examined in PD and healthy comparisons in an unconstrained three-dimensional coordination task. PD were tested “off” (overnight withdrawal of dopaminergic treatment) and “on” (peak dose of dopaminergic treatment), while the healthy group was evaluated for practice effects across two sessions. Required cycle frequency (increased within each trial from 0.75 to 2 Hz), type of visual feedback (no vision, normal vision, and augmented vision), and coordination pattern (symmetrical in-phase and non-symmetrical anti-phase) were all manipulated. Overall, coordination (mean accuracy and standard deviation of relative phase) and amplitude deficits during bimanual coordination were confirmed in PD participants. In addition, significant correlations were identified between severity of motor symptoms as well as bradykinesia to greater coordination deficits (accuracy and stability) in PD “off” group. However, even though amplitude deficits (hypokinesia) improved with dopaminergic replacement, it did not improve bimanual coordination performance (accuracy or stability) in PD patients from “off” to “on.” Interestingly, while coordination performance in both groups suffered in the augmented vision condition, the amplitude of the more affected limb of PD was notably influenced. It can be concluded that DOPA-responsive hypokinesia contributes to, but is not directly responsible for bimanual coordination impairments in PD. It is likely that bimanual coordination deficits in PD are caused by the combination of dopaminergic system dysfunction as well as other neural impairments that may be DOPA-resistant or related to non-dopaminergic pathways.
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Affiliation(s)
- Quincy J Almeida
- Sun Life Financial Movement Disorders Research and Rehabilitation Centre (MDRC), Wilfrid Laurier University , Waterloo, ON , Canada
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Mohlman J, Chazin D, Georgescu B. Feasibility and acceptance of a nonpharmacological cognitive remediation intervention for patients with Parkinson disease. J Geriatr Psychiatry Neurol 2011; 24:91-7. [PMID: 21546649 DOI: 10.1177/0891988711402350] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Many patients with idiopathic Parkinson disease (PD) experience deficits in executive skills (ES; eg, attentional control, self-monitoring), which are associated with a range of impairing symptoms such as visual hallucinations, decreased motor control, and increased apathy. Pharmacological methods for improving ES in PD have shown to be somewhat unreliable. The goal of this study was to evaluate the feasibility and patient acceptance of a nonpharmacological cognitive remediation program that aimed to improve sustained, selective, alternating, and divided attentional abilities in a sample of 16 nondemented PD patients. Based on ratings of 4 feasibility dimensions (fatigue, effort, progress, enjoyment), patients with PD demonstrated a high degree of acceptance and successfully engaged in the program. As predicted, ratings of progress differed significantly across tasks according to difficulty level and were positively related to posttraining improvement in ES. Fatigue ratings showed negative associations with other indices across task types, suggesting that monitoring fatigue during cognitive remediation is essential. Patients' ratings of enjoyment did not correspond to task difficulty, indicating that tasks could be simultaneously challenging and rewarding. Males reported exerting greater effort during the training than females. It was concluded that the intervention is appropriate for testing in a randomized controlled trial.
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Affiliation(s)
- Jan Mohlman
- Department of Psychology, Rutgers, the State University of New Jersey, Piscataway, NJ 08854, USA.
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Nayyar T, Bubser M, Ferguson MC, Neely MD, Shawn Goodwin J, Montine TJ, Deutch AY, Ansah TA. Cortical serotonin and norepinephrine denervation in parkinsonism: preferential loss of the beaded serotonin innervation. Eur J Neurosci 2010; 30:207-16. [PMID: 19659923 DOI: 10.1111/j.1460-9568.2009.06806.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Parkinson's Disease (PD) is marked by prominent motor symptoms that reflect striatal dopamine insufficiency. However, non-motor symptoms, including depression, are common in PD. It has been suggested that these changes reflect pathological involvement of non-dopaminergic systems. We examined regional changes in serotonin (5-HT) and norepinephrine (NE) systems in mice treated with two different 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) treatment paradigms, at survival times of 3 or 16 weeks after the last MPTP injection. MPTP caused a decrease in striatal dopamine concentration, the magnitude of which depended on the treatment regimen and survival interval after MPTP treatment. There was significant involvement of other subcortical areas receiving a dopamine innervation, but no consistent changes in 5-HT or NE levels in subcortical sites. In contrast, we observed an enduring decrease in 5-HT and NE concentrations in both the somatosensory cortex and medial prefrontal cortex (PFC). Immunohistochemical studies also revealed a decrease in the density of PFC NE and 5-HT axons. The decrease in the cortical serotonergic innervation preferentially involved the thick beaded but not smooth fine 5-HT axons. Similar changes in the 5-HT innervation of post-mortem samples of the PFC from idiopathic PD cases were seen. Our findings point to a major loss of the 5-HT and NE innervations of the cortex in MPTP-induced parkinsonism, and suggest that loss of the beaded cortical 5-HT innervation is associated with a predisposition to the development of depression in PD.
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Affiliation(s)
- Tultul Nayyar
- Department of Neurobiology and Neurotoxicology, Meharry Medical College, Nashville, TN 37208, USA
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Mohlman J, Reel DH, Chazin D, Ong D, Georgescu B, Tiu J, Dobkin RD. A Novel Approach to Treating Anxiety and Enhancing Executive Skills in an Older Adult with Parkinson's Disease. Clin Case Stud 2009; 9:74-90. [PMID: 20419071 DOI: 10.1177/1534650109351305] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scientific interest in the nonmotoric symptoms of Parkinson's disease (PD) has increased dramatically, and psychiatric symptoms (e.g., cognitive impairment, anxiety and mood disorders) are now considered prime targets for treatment optimization. Psychiatric complications in PD are quite common, affecting as many as 60 to 80% of patients. This study describes the case of a 74 year-old male with PD who presented with complaints of anxiety and trouble with memory and attention. A combined cognitive behavior therapy and cognitive enhancement intervention was delivered in ten 90-to-120 minute sessions. The patient showed a reduction in anxiety symptoms that was of sufficient magnitude to meet criteria for 'responder' status. His cognitive skills were mostly unchanged, despite the rigorous rehabilitation practice. Implications for treatment and strategies for enhancing therapeutic benefits are discussed.
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Dézsi L, Vécsei L. Established therapies and novel targets in the treatment of Parkinson's disease. Expert Rev Clin Pharmacol 2009; 2:631-44. [PMID: 22112257 DOI: 10.1586/ecp.09.47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Parkinson's disease affects more than 1% of individuals older than 60 years of age. The gold standard of its symptomatic treatment is levodopa therapy, which in time leads to motor fluctuations and dyskinesia due to noncontinuous receptor stimulation. Dopamine agonists and monoamine oxidase-B inhibitors are recommended as initial therapy, but they are less effective in the advanced stages of the disease. Treatment should be individualized for the patient, dependent on the stage, with attention to nonmotor symptoms. No effective neuroprotective therapy for Parkinson's disease is yet available, and there is currently substantial interest in the development of new nondopaminergic agents. Analogs of kynurenic acid and inhibitors of the enzymes involved in the synthesis of quinolinic acid may exert a neuroprotective effect.
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Affiliation(s)
- Livia Dézsi
- Neurologist, Neurology Department, Faculty of Medicine, University of Szeged, H-6725 Szeged, Semmelweis u. 6. Hungary.
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Leroi I, Overshott R, Byrne EJ, Daniel E, Burns A. Randomized controlled trial of memantine in dementia associated with Parkinson's disease. Mov Disord 2009; 24:1217-21. [PMID: 19370737 DOI: 10.1002/mds.22495] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The objective of this study is to investigate the safety and tolerability of memantine, a glutamatergic modulator, in patients suffering from dementia associated with Parkinson's disease (PDD), an increasingly common complication of PD. This was a 22-week trial of 25 participants with a DSM-IV diagnosis of PDD who were randomized to either placebo or 20 mg/day of memantine. Memantine was well tolerated by participants at 20 mg/day dosing. No participant was withdrawn due to memantine-related adverse events. Six weeks after drug withdrawal, a significantly greater proportion (P = 0.04) of memantine-treated participants deteriorated globally compared with those treated with placebo. These findings suggest that continued treatment with memantine may be needed to maintain global level of functioning over time. Based on the findings of this pilot study, memantine is safe and very well-tolerated in PDD.
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Affiliation(s)
- Iracema Leroi
- Lancashire Care Trust, Royal Blackburn Hospital, Blackburn, United Kingdom.
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Tröster AI. Neuropsychological characteristics of dementia with Lewy bodies and Parkinson's disease with dementia: differentiation, early detection, and implications for "mild cognitive impairment" and biomarkers. Neuropsychol Rev 2008; 18:103-19. [PMID: 18322801 DOI: 10.1007/s11065-008-9055-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 01/26/2008] [Indexed: 01/09/2023]
Abstract
Parkinson's disease with dementia (PDD) and dementia with Lewy bodies (DLB) are neurodegenerative conditions sharing a disorder of alpha-synuclein metabolism. Temporal differences in the emergence of symptoms and clinical features warrant the continued clinical distinction between DLB and PDD. While DLB and PDD groups' neuropsychological profiles often differ from those in Alzheimer's disease (AD), the diagnostic sensitivity, specificity, and predictive values of these profiles remain largely unknown. PDD and DLB neuropsychological profiles share sufficient similarity to resist accurate and reliable differentiation. Although heterogeneous cognitive changes (predominantly in memory and executive function) may manifest earlier and more frequently than previously appreciated in Parkinson's disease (PD), and executive deficits may be harbingers of dementia, the enthusiasm to uncritically extend the concept of mild cognitive impairment (MCI) to PD should be tempered. Instead, future research might strive to identify the precise neuropsychological characteristics of the prodromal stages of PD, PDD, and DLB which, in conjunction with other potential biomarkers, facilitate early and accurate diagnosis, and the definition of neuroprotective, neurorestorative, and symptomatic treatment endpoints.
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Affiliation(s)
- Alexander I Tröster
- Department of Neurology (CB 7025), University of North Carolina at Chapel Hill, 3114 Bioinformatics Building, Chapel Hill, NC 27599-7025, USA.
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