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Saunders-Pullman R, Ortega RA, Wang C, Raymond D, Elango S, Leaver K, Urval N, Katsnelson V, Gerber R, Swan M, Shanker V, Alcalay RN, Mirelman A, Brumm MC, Mejia-Santana H, Coffey CS, Marek K, Ozelius LJ, Giladi N, Marder KS, Bressman SB. Association of Olfactory Performance With Motor Decline and Age at Onset in People With Parkinson Disease and the LRRK2 G2019S Variant. Neurology 2022; 99:e814-e823. [PMID: 35995594 PMCID: PMC9484727 DOI: 10.1212/wnl.0000000000200737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/30/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is clinical and phenotypic heterogeneity in LRRK2 G2019S Parkinson disease (PD), including loss of smell. Olfactory scores have defined subgroups of LRRK2 PD at baseline. We now extend this work longitudinally to better determine features associated with olfactory classes and to gain further insight into this heterogeneity. METHODS Evaluation of 162 patients with LRRK2 PD and 198 patients with idiopathic PD (IPD) from the LRRK2 Ashkenazi Jewish Consortium was performed, with follow-up available for 92 patients with LRRK2 PD and 74 patients with IPD. Olfaction (University of Pennsylvania Smell Identification Test [UPSIT]), motor function (Unified Parkinson Disease Rating Scale), and cognition (Montreal Cognitive Assessment), as well as sleep, nonmotor, and mood, were measured. Gaussian mixture models were applied on the UPSIT percentile score to determine subgroups based on olfactory performance. Linear mixed effects models, using PD duration as the time scale, assessed the relationship between UPSIT subgroup membership and motor/cognitive change. RESULTS Baseline olfaction was better in LRRK2 PD compared with IPD (mean UPSIT ± SD: 24.2 ± 8.8 vs 18.9 ± 7.6), with higher mean percentile scores (difference: 15.3 ± 11.6) (p < 0.001) and less frequent hyposmia (55.6% vs 85.4%; p < 0.001). Analysis suggested 3 classes among LRRK2 PD. Age at onset in LRRK2 PD was earlier in the worst olfaction group (group 1), compared with groups 2 and 3 (54.5 ± 11.1 vs 61.7 ± 9.3) (p = 0.012), and separately in the hyposmic group overall (55.0 ± 11.3 vs 61.7 ± 9.1) (p < 0.001). Longitudinal motor deterioration in LRRK2 PD was also significantly faster in the worst UPSIT group than the best UPSIT group (group 3 vs group 1: B = 0.31, SE = 0.35 vs B = 0.96, SE = 0.28) (rate difference = -0.65, SE = 0.29) (p = 0.03). However, olfactory group membership was not significantly associated with cognitive decline. DISCUSSION In this large LRRK2 cohort with longitudinal analysis, we extend prior work demonstrating subgroups defined by olfaction in LRRK2 G2019S PD and show that the worst olfaction group has earlier age at PD onset and more rapid motor decline. This supports a subgroup of LRRK2 PD that might show more rapid change in a clinical trial of LRRK2-related agents and highlights the need to integrate careful phenotyping into allocation schema in clinical trials of LRRK2-related agents. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that worse olfactory scores were associated with an earlier age at symptomatic onset and a faster rate of motor deterioration in patients with LRRK2 PD.
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Affiliation(s)
- Rachel Saunders-Pullman
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston.
| | - Roberto Angel Ortega
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Cuiling Wang
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Deborah Raymond
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Sonya Elango
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Katherine Leaver
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Nikita Urval
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Viktoriya Katsnelson
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Rachel Gerber
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Matthew Swan
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Vicki Shanker
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Roy N Alcalay
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Anat Mirelman
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Michael C Brumm
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Helen Mejia-Santana
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Christopher S Coffey
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Kenneth Marek
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Laurie J Ozelius
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Nir Giladi
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Karen S Marder
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
| | - Susan B Bressman
- From the Department of Neurology (R.S.-P., R.A.O., D.R., S.E., K.L., N.U., V.K., R.G., M.S., V.S., S.B.B.), Mount Sinai Beth Israel; Albert Einstein College of Medicine (C.W.), Bronx, NY; Department of Neurology (R.N.A., H.M.-S., K.S.M.), Columbia University Irving Medical Center, New York; Neurological Institute (A.M., N.G.), Tel Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neurosciences, Tel Aviv University, Israel; University of Iowa Carver College of Medicine (M.C.B., C.S.C.), and Biostatistics (M.C.B., C.S.C.), University of Iowa, Iowa City; Department of Neurology (K.M.), Institute for Neurodegenerative Disorders, New Haven, CT; and Department of Genetics (L.J.O.), Massachusetts General Hospital, Boston
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Mestre TA, Pont-Sunyer C, Kausar F, Visanji NP, Ghate T, Connolly BS, Gasca-Salas C, Kern DS, Jain J, Slow EJ, Faust-Socher A, Kasten M, Wadia PM, Zadikoff C, Kumar P, de Bie RM, Thomsen T, Lang AE, Schüle B, Klein C, Tolosa E, Marras C. Clustering of motor and nonmotor traits in leucine-rich repeat kinase 2 G2019S Parkinson's disease nonparkinsonian relatives: A multicenter family study. Mov Disord 2018; 33:960-965. [PMID: 29665080 DOI: 10.1002/mds.27272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine phenotypic features that differentiate nonparkinsonian first-degree relatives of PD leucine-rich repeat kinase 2 (LRRK2) G2019S multiplex families, regardless of carrier status, from healthy controls because nonparkinsonian individuals in multiplex families seem to share a propensity to present neurological features. METHODS We included nonparkinsonian first-degree relatives of LRRK2 G2019S familial PD cases and unrelated healthy controls participating in established multiplex family LRRK2 cohorts. Study participants underwent neurologic assessment including cognitive screening, olfaction testing, and questionnaires for daytime sleepiness, depression, and anxiety. We used a multiple logistic regression model with backward variable selection, validated with bootstrap resampling, to establish the best combination of motor and nonmotor features that differentiates nonparkinsonian first-degree relatives of LRRK2 G2019S familial PD cases from unrelated healthy controls. RESULTS We included 142 nonparkinsonian family members and 172 unrelated healthy controls. The combination of past or current symptoms of anxiety (adjusted odds ratio, 4.16; 95% confidence interval, 2.01-8.63), less daytime sleepiness (adjusted odds ratio [1 unit], 0.90; 95% confidence interval, 0.83-0.97], and worse motor UPDRS score (adjusted odds ratio [1 unit], 1.4; 95% confidence interval, 1.20-1.67) distinguished nonparkinsonian family members, regardless of LRRK2 G2019S mutation status, from unrelated healthy controls. The model accuracy was good (area under the curve = 79.3%). CONCLUSIONS A set of motor and nonmotor features distinguishes first-degree relatives of LRRK2 G2019S probands, regardless of mutation status, from unrelated healthy controls. Environmental or non-LRRK2 genetic factors in LRRK2-associated PD may influence penetrance of the LRRK2 G2019S mutation. The relationship of these features to actual PD risk requires longitudinal observation of LRRK2 familial PD cohorts. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Tiago A Mestre
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada.,Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Institute, Ottawa, Canada (current affiliation)
| | - Claustre Pont-Sunyer
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Barcelona, Spain.,Neurology Unit, Hospital General de Granollers, Universitat Internacional de Catalunya, Granollers, Spain, Barcelona
| | - Farah Kausar
- Parkinson's Institute and Clinical Center, Sunnyvale, California, USA
| | - Naomi P Visanji
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada
| | - Taneera Ghate
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada
| | - Barbara S Connolly
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada
| | - Carmen Gasca-Salas
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada.,Centro Integral en Neurociencias Abarca Cidón, Hospitales de Madrid Hospitales Puerta del Sur, CEU San Pablo University, Madrid, Spain (current affiliation)
| | - Drew S Kern
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada.,Department of Neurology, Movement Disorders Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA (current affiliation)
| | - Jennifer Jain
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada
| | - Elizabeth J Slow
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada
| | - Achinoam Faust-Socher
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada
| | - Meike Kasten
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Pettarusp M Wadia
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada.,Department of Neurology, Jaslok Hospital and Research Centre, Mumbai, India (current affiliation)
| | - Cindy Zadikoff
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada
| | - Prakash Kumar
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada
| | - Ronald M de Bie
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada.,Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (current affiliation)
| | - Teri Thomsen
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada.,Neurology Department, University of Iowa, Iowa City, Iowa, USA (current affiliation)
| | - Anthony E Lang
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada
| | - Birgitt Schüle
- Parkinson's Institute and Clinical Center, Sunnyvale, California, USA
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Eduardo Tolosa
- Parkinson's Disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Barcelona, Spain
| | - Connie Marras
- Movement Disorders Centre, Toronto Western Hospital, and the Edmond J Safra program in Parkinson's Research, Toronto, Canada
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