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Ruiz Barrio I, Miki Y, Jaunmuktane ZT, Warner T, De Pablo-Fernandez E. Association Between Orthostatic Hypotension and Dementia in Patients With Parkinson Disease and Multiple System Atrophy. Neurology 2023; 100:e998-e1008. [PMID: 36526431 PMCID: PMC9990860 DOI: 10.1212/wnl.0000000000201659] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/21/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Orthostatic hypotension (OH) increases dementia risk in patients with Parkinson disease (PD), although the underlying mechanisms and whether a similar association between OH and cognitive impairment exists in other synucleinopathies remain unknown. The aim is to evaluate the association between OH and dementia risk in patients with PD, and cognitive impairment risk in patients with multiple system atrophy (MSA), and to explore relevant clinical and neuropathologic factors to understand underlying pathogenic mechanisms. METHODS This is a retrospective cohort study. Medical records throughout the entire disease course of consecutive patients with neuropathology-confirmed PD and MSA from the Queen Square Brain Bank were systematically reviewed. Time of onset and severity of OH-related symptoms were documented, and their association with other clinical and neuropathologic variables was evaluated. Dementia risk for patients with PD and cognitive impairment risk for patients with MSA were estimated using multivariable hazard regression. RESULTS One hundred thirty-two patients with PD and 137 with MSA were included. Patients with MSA developed OH more frequently, earlier in the disease course and with more severe symptoms. Cumulative dementia prevalence was higher in patients with PD. Multivariable adjusted regression models showed that early OH, but not its symptom severity, increased dementia risk in patients with PD by 14% per year (hazard ratio [HR] = 0.86; 95% CI, 0.80-0.93) and cognitive impairment risk in patients with MSA by 41% per year (HR = 0.59; 95% CI, 0.42-0.83). Early OH was not associated with increased α-synuclein, β-amyloid, tau, Alzheimer, or cerebrovascular pathologies. No significant associations were found between severity of OH symptoms and other clinical or neuropathologic variables. DISCUSSION Early OH, but not its symptom severity, increases the risk of cognitive impairment in patients with PD and MSA. OH is not associated with more extensive Lewy, β-amyloid, tau, Alzheimer, or cerebrovascular pathologies. It is likely that OH contributes to cognitive impairment in patients with PD and MSA by hypoxia-induced nonspecific neurodegeneration. Further research should evaluate whether improving brain perfusion by treating OH may modify the risk of dementia in these conditions.
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Affiliation(s)
- Iñigo Ruiz Barrio
- From the Queen Square Brain Bank for Neurological Disorders, (I.R.B., Y.M., Z.T.J., T.W., E.d.P-F.), and Reta Lila Weston Institute of Neurological Studies (T.W., E.d.P-F.), Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology, London, United Kingdom; Movement Disorders Unit, (I.R.B.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; and Department of Neuropathology (Y.M.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuo Miki
- From the Queen Square Brain Bank for Neurological Disorders, (I.R.B., Y.M., Z.T.J., T.W., E.d.P-F.), and Reta Lila Weston Institute of Neurological Studies (T.W., E.d.P-F.), Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology, London, United Kingdom; Movement Disorders Unit, (I.R.B.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; and Department of Neuropathology (Y.M.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Zane T Jaunmuktane
- From the Queen Square Brain Bank for Neurological Disorders, (I.R.B., Y.M., Z.T.J., T.W., E.d.P-F.), and Reta Lila Weston Institute of Neurological Studies (T.W., E.d.P-F.), Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology, London, United Kingdom; Movement Disorders Unit, (I.R.B.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; and Department of Neuropathology (Y.M.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Thomas Warner
- From the Queen Square Brain Bank for Neurological Disorders, (I.R.B., Y.M., Z.T.J., T.W., E.d.P-F.), and Reta Lila Weston Institute of Neurological Studies (T.W., E.d.P-F.), Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology, London, United Kingdom; Movement Disorders Unit, (I.R.B.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; and Department of Neuropathology (Y.M.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eduardo De Pablo-Fernandez
- From the Queen Square Brain Bank for Neurological Disorders, (I.R.B., Y.M., Z.T.J., T.W., E.d.P-F.), and Reta Lila Weston Institute of Neurological Studies (T.W., E.d.P-F.), Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology, London, United Kingdom; Movement Disorders Unit, (I.R.B.), Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; and Department of Neuropathology (Y.M.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
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Nasri A, Gharbi A, Sghaier I, Mrabet S, Souissi A, Gargouri A, Djebara MB, Kacem I, Gouider R. Determinants of cognitive impairment in multiple system atrophy: Clinical and genetic study. PLoS One 2022; 17:e0277798. [PMID: 36508411 PMCID: PMC9744291 DOI: 10.1371/journal.pone.0277798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/03/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Classically, cognitive impairment (CI) was not considered as a paramount feature of multiple system atrophy(MSA) in both parkinsonian(MSA-P) and cerebellar(MSA-C) motor-subtypes. Yet, growing evidence indicates currently the commonness of such deficits among MSA patients in different populations. Our aim was to evaluate the cognitive profile of MSA Tunisian patients and to analyze the underlying clinical and genetic determinants. METHODS In a retrospective cross-sectional study, clinically-diagnosed MSA patients were included. All subjects underwent clinical and neuropsychological assessments to characterize their cognitive profile. The associations with their APOE genotype status were analyzed. Determinant of CI were specified. RESULTS We included 71 MSA patients. Female gender(sex-ratio = 0.65) and MSA-P subtype(73%) were predominant. Mean age of disease onset was 59.1years. CI was found in 85.7% of patients(dementia in 12.7% and Mild cognitive impairment(MCI) in 73% of patients mainly of multiple-domain amnestic type(37.3%)). Mean MMSE score was lower among MSA-P compared to MSA-C(23.52 vs. 26.47;p = 0.027). Higher postural instability gait disorder(PIGD) and MDS-UPDRS-III scores were noted in demented MSA patients(p = 0.019;p = 0.015 respectively). The main altered cognitive domain was attention(64.8%). Executive functions and mood disorders were more affected in MSA-P(p = 0.029,p = 0.035 respectively). Clinical and neurophysiological study of dysautonomia revealed no differences across cognitive subtypes. APOE genotyping was performed in 51 MSA patients with available blood samples. Those carrying APOEε4 had 1.32 fold higher risk to develop CI, with lower MMSE score(p = 0.0001). Attention and language were significantly altered by adjusting the p value to APOEɛ4 carriers(p = 0.046 and p = 0.044 respectively). Executive dysfunction was more pronounced among MSA-PAPOEε4 carriers(p = 0.010). CONCLUSION In this study, the main determinants of CI in Tunisian MSA patients were MSA-P motor-subtype, mainly of PIGD-phenotype, disease duration and APOEε4 carrying status, defining a more altered cognitive phenotype. This effect mainly concerned executive, attention and language functions, all found to be more impaired in APOEε4 carriers with variable degrees across MSA motor-subtypes.
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Affiliation(s)
- Amina Nasri
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Alya Gharbi
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Ikram Sghaier
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Saloua Mrabet
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Amira Souissi
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Amina Gargouri
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Mouna Ben Djebara
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Imen Kacem
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
| | - Riadh Gouider
- Neurology Department, LR18SP03, Razi Universitary Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center (CIC) "Neurosciences and Mental Health", Razi Universitary Hospital, Tunis, Tunisia
- * E-mail:
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Du L, Hu X, Zhang B, Miao X, Wang J, Shen J, Ding K, Zeng T, Sun F, Yang H, Lin H. The relationship of platelet-to-lymphocyte ratio with cognitive decline in T2DM. Diabetol Metab Syndr 2021; 13:151. [PMID: 34952622 PMCID: PMC8710029 DOI: 10.1186/s13098-021-00772-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/15/2021] [Indexed: 12/04/2022] Open
Abstract
PURPOSE We aimed to investigate the role of platelet-to-lymphocyte ratio (PLR) in cognitive decline in patients with type 2 diabetes mellitus (T2DM). METHODS A total number of 261 T2DM patients were enrolled in this study. The T2DM patients were divided into two groups according to the median of PLR (PLR < 96.5, n = 130; PLR ≥ 96.5, n = 131). Cognitive impairment was defined as Mini-mental State Examination score ≤ 26. Student's t test and Chi-square test were used to test the difference between the groups, and logistics regression analysis were performed to verify whether high PLR was an independent factor for cognitive impairment. RESULTS T2DM patients with cognitive impairment had significantly higher PLR level when compared with the simple diabetes group (p = 0.003). Incidence of cognitive impairment was higher in the high PLR group, compared to low PLR group (p = 0.040). Multivariate logistic regression analysis suggested that PLR was a risk biomarker of cognitive decline in T2DM patients (odds ratio [OR] = 1.010, 95% CI: 1.001-1.018, p = 0.013). CONCLUSIONS We demonstrated that a higher PLR was associated with cognitive decline in T2DM patients. The PLR may help to identify high-risk patients in time and provide clues for further prevention of cognitive dysfunction in T2DM patients.
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Affiliation(s)
- Licheng Du
- Department of Endocrinology, The Third Affiliated Hospital of Wenzhou Medical University, NO.108 Wansong Road, Wenzhou, 325000, Zhejiang, China
| | - Xueting Hu
- Department of Endocrinology, The Third Affiliated Hospital of Wenzhou Medical University, NO.108 Wansong Road, Wenzhou, 325000, Zhejiang, China
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Beibei Zhang
- Department of Gastroenterology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaqi Miao
- Department of Endocrinology, The Third Affiliated Hospital of Wenzhou Medical University, NO.108 Wansong Road, Wenzhou, 325000, Zhejiang, China
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Jianing Wang
- Department of Endocrinology, The Third Affiliated Hospital of Wenzhou Medical University, NO.108 Wansong Road, Wenzhou, 325000, Zhejiang, China
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Jiamin Shen
- Department of Endocrinology, The Third Affiliated Hospital of Wenzhou Medical University, NO.108 Wansong Road, Wenzhou, 325000, Zhejiang, China
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Keke Ding
- Department of Endocrinology, The Third Affiliated Hospital of Wenzhou Medical University, NO.108 Wansong Road, Wenzhou, 325000, Zhejiang, China
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Tian Zeng
- Department of Endocrinology, The Third Affiliated Hospital of Wenzhou Medical University, NO.108 Wansong Road, Wenzhou, 325000, Zhejiang, China
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Fangyue Sun
- Department of Endocrinology, The Third Affiliated Hospital of Wenzhou Medical University, NO.108 Wansong Road, Wenzhou, 325000, Zhejiang, China
- School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Hong Yang
- Department of Endocrinology, The Third Affiliated Hospital of Wenzhou Medical University, NO.108 Wansong Road, Wenzhou, 325000, Zhejiang, China.
| | - Hai Lin
- Department of Endocrinology, The Third Affiliated Hospital of Wenzhou Medical University, NO.108 Wansong Road, Wenzhou, 325000, Zhejiang, China.
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Cuoco S, Carotenuto I, Cappiello A, Scannapieco S, Russillo MC, Andreozzi V, Forino L, Amboni M, Picillo M, Erro R, Barone P, Pellecchia MT. Relationship Between Orthostatic Hypotension and Cognitive Functions in Multiple System Atrophy: A Longitudinal Study. Front Neurol 2021; 12:711358. [PMID: 34539557 PMCID: PMC8446504 DOI: 10.3389/fneur.2021.711358] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The aim of this study is to investigate the impact of orthostatic hypotension (OH) on cognitive functions in patients with multiple system atrophy (MSA) followed over time. Methods: Thirty-two MSA patients were enrolled and underwent a comprehensive neuropsychological battery; at baseline (T0) 15 out of 32 patients presented OH, assessed by means of orthostatic standing test. All patients underwent a follow-up (T1) evaluation 12 months after baseline. Thirteen out of 32 patients also underwent a second follow-up (T2) evaluation at 24 months. Changes over time on different neuropsychological tasks were compared between patients with and without OH by means of Mann-Whitney's U-test. Moreover, clinical categories of normal cognition, mild cognitive impairment, and dementia were determined, and changes at T1 and T2 in global cognitive status were compared between patients with and without OH. Results: At T0, patients with OH had better performance on words/non-words repetition task (p = 0.02) compared to patients without OH. Compared to patients without OH, patients with OH performed worse on semantic association task (p < 0.01) at T1 and on Stroop test-error effect (p = 0.04) at T2. The percentage of patients with worsened cognitive status at T1 was higher among patients with OH than among patients without OH (93 vs. 59%, p = 0.03). OH (β = -4.67, p = 0.01), education (β = 0.45, p = 0.02), age (β = 0.19, p = 0.03), and Montreal Cognitive Assessment battery (MOCA) score at T0 (β = -0.26, p = 0.04) were significant predictors of global cognitive status worsening at T1. Discussion: We found that global cognitive status worsened at 1-year follow-up in 93% of patients with OH, and OH, along with age, education, and MOCA score, predicted cognitive worsening over time. To clarify the relationship between OH and cognitive dysfunction in MSA, we suggest the use of clinical categories of normal cognition, mild cognitive impairment, and dementia in further longitudinal studies on MSA patients with and without OH.
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Affiliation(s)
- Sofia Cuoco
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Immacolata Carotenuto
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Arianna Cappiello
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Sara Scannapieco
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Maria Claudia Russillo
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Valentina Andreozzi
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Lorenzo Forino
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Marianna Amboni
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Marina Picillo
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Roberto Erro
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Paolo Barone
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
| | - Maria Teresa Pellecchia
- Center for Neurodegenerative diseases (CEMAND), Department of Medicine, Surgery and Dentistry, Neuroscience section, University of Salerno, Salerno, Italy
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Current experimental disease-modifying therapeutics for multiple system atrophy. J Neural Transm (Vienna) 2021; 128:1529-1543. [PMID: 34398313 PMCID: PMC8528757 DOI: 10.1007/s00702-021-02406-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023]
Abstract
Multiple system atrophy (MSA) is a challenging neurodegenerative disorder with a difficult and often inaccurate early diagnosis, still lacking effective treatment. It is characterized by a highly variable clinical presentation with parkinsonism, cerebellar ataxia, autonomic dysfunction, and pyramidal signs, with a rapid progression and an aggressive clinical course. The definite MSA diagnosis is only possible post-mortem, when the presence of distinctive oligodendroglial cytoplasmic inclusions (GCIs), mainly composed of misfolded and aggregated α-Synuclein (α-Syn) is demonstrated. The process of α-Syn accumulation and aggregation within oligodendrocytes is accepted one of the main pathological events underlying MSA. However, MSA is considered a multifactorial disorder with multiple pathogenic events acting together including neuroinflammation, oxidative stress, and disrupted neurotrophic support, among others. The discussed here treatment approaches are based on our current understanding of the pathogenesis of MSA and the results of preclinical and clinical therapeutic studies conducted over the last 2 decades. We summarize leading disease-modifying approaches for MSA including targeting α-Syn pathology, modulation of neuroinflammation, and enhancement of neuroprotection. In conclusion, we outline some challenges related to the need to overcome the gap in translation between preclinical and clinical studies towards a successful disease modification in MSA.
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