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Schmitz M, Candelise N, Canaslan S, Altmeppen HC, Matschke J, Glatzel M, Younas N, Zafar S, Hermann P, Zerr I. α-Synuclein conformers reveal link to clinical heterogeneity of α-synucleinopathies. Transl Neurodegener 2023; 12:12. [PMID: 36915212 PMCID: PMC10012698 DOI: 10.1186/s40035-023-00342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/13/2023] [Indexed: 03/15/2023] Open
Abstract
α-Synucleinopathies, such as Parkinson's disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy, are a class of neurodegenerative diseases exhibiting intracellular inclusions of misfolded α-synuclein (αSyn), referred to as Lewy bodies or oligodendroglial cytoplasmic inclusions (Papp-Lantos bodies). Even though the specific cellular distribution of aggregated αSyn differs in PD and DLB patients, both groups show a significant pathological overlap, raising the discussion of whether PD and DLB are the same or different diseases. Besides clinical investigation, we will focus in addition on methodologies, such as protein seeding assays (real-time quaking-induced conversion), to discriminate between different types of α-synucleinopathies. This approach relies on the seeding conversion properties of misfolded αSyn, supporting the hypothesis that different conformers of misfolded αSyn may occur in different types of α-synucleinopathies. Understanding the pathological processes influencing the disease progression and phenotype, provoked by different αSyn conformers, will be important for a personalized medical treatment in future.
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Affiliation(s)
- Matthias Schmitz
- Department of Neurology, National Reference Center for TSE, The German Center for Neurodegenerative Diseases (DZNE), Georg-August-University, University Medicine Gottingen, Goettingen, Germany.
| | - Niccolò Candelise
- National Center for Drug Research and Evaluation, Institute Superiore di Sanità, Rome, Italy
| | - Sezgi Canaslan
- Department of Neurology, National Reference Center for TSE, The German Center for Neurodegenerative Diseases (DZNE), Georg-August-University, University Medicine Gottingen, Goettingen, Germany
| | - Hermann C Altmeppen
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jakob Matschke
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Neelam Younas
- Department of Neurology, National Reference Center for TSE, The German Center for Neurodegenerative Diseases (DZNE), Georg-August-University, University Medicine Gottingen, Goettingen, Germany
| | - Saima Zafar
- Department of Neurology, National Reference Center for TSE, The German Center for Neurodegenerative Diseases (DZNE), Georg-August-University, University Medicine Gottingen, Goettingen, Germany
| | - Peter Hermann
- Department of Neurology, National Reference Center for TSE, The German Center for Neurodegenerative Diseases (DZNE), Georg-August-University, University Medicine Gottingen, Goettingen, Germany
| | - Inga Zerr
- Department of Neurology, National Reference Center for TSE, The German Center for Neurodegenerative Diseases (DZNE), Georg-August-University, University Medicine Gottingen, Goettingen, Germany
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Segovia F, Górriz JM, Ramírez J, Martínez-Murcia FJ, Castillo-Barnes D. Assisted Diagnosis of Parkinsonism Based on the Striatal Morphology. Int J Neural Syst 2019; 29:1950011. [PMID: 31084232 DOI: 10.1142/s0129065719500114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Parkinsonism is a clinical syndrome characterized by the progressive loss of striatal dopamine. Its diagnosis is usually corroborated by neuroimaging data such as DaTSCAN neuroimages that allow visualizing the possible dopamine deficiency. During the last decade, a number of computer systems have been proposed to automatically analyze DaTSCAN neuroimages, eliminating the subjectivity inherent to the visual examination of the data. In this work, we propose a computer system based on machine learning to separate Parkinsonian patients and control subjects using the size and shape of the striatal region, modeled from DaTSCAN data. First, an algorithm based on adaptative thresholding is used to parcel the striatum. This region is then divided into two according to the brain hemisphere division and characterized with 152 measures, extracted from the volume and its three possible 2-dimensional projections. Afterwards, the Bhattacharyya distance is used to discard the least discriminative measures and, finally, the neuroimage category is estimated by means of a Support Vector Machine classifier. This method was evaluated using a dataset with 189 DaTSCAN neuroimages, obtaining an accuracy rate over 94%. This rate outperforms those obtained by previous approaches that use the intensity of each striatal voxel as a feature.
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Affiliation(s)
- Fermín Segovia
- Department of Signal Theory, Networking and Communications, DASCI Institute, University of Granada, Granada 18071, Spain
| | - Juan M. Górriz
- Department of Signal Theory, Networking and Communications, DASCI Institute, University of Granada, Granada 18071, Spain
| | - Javier Ramírez
- Department of Signal Theory, Networking and Communications, DASCI Institute, University of Granada, Granada 18071, Spain
| | - Francisco J. Martínez-Murcia
- Department of Signal Theory, Networking and Communications, DASCI Institute, University of Granada, Granada 18071, Spain
| | - Diego Castillo-Barnes
- Department of Signal Theory, Networking and Communications, DASCI Institute, University of Granada, Granada 18071, Spain
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Vale TC, Barbosa MT, Resende EDPF, Maia DP, Cunningham MCQ, Guimarães HC, Machado JCB, Teixeira AL, Cardoso F, Caramelli P. Parkinsonism in a population-based study of individuals aged 75+ years: The Pietà study. Parkinsonism Relat Disord 2018; 56:76-81. [PMID: 29934195 DOI: 10.1016/j.parkreldis.2018.06.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/05/2018] [Accepted: 06/18/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Parkinsonism is one of the most prevalent neurological syndromes in the elderly. There are only a few epidemiological studies focusing on parkinsonism in oldest-old individuals, particularly in Latin America. This study aims to investigate the prevalence and characteristics of parkinsonism in subjects aged 75 + years living in the community. METHODS The Pietà study is a population-based investigation on brain aging conducted in Caeté, southeast Brazil. A sample composed of 610 community-dwelling individuals aged 75 + years (48.7% of the total population within this age range) underwent clinical, neurological, cognitive and functional assessments. RESULTS The sample comprised mostly women (61.5%), with mean age of 83.3 years and mean schooling of 2.5 years. Parkinsonism was identified in 65 subjects (crude prevalence = 10.7%). Parkinson's disease, Parkinsonism + dementia syndrome, drug-induced parkinsonism, vascular parkinsonism and Lewy-body dementia were identified in, respectively, 19 (29.2%), 19 (29.2%), 8 (12.3%), 4 (6.1%) and 1 (1.5%) subjects. In 14 individuals (21.5%), the etiology of parkinsonism could not be determined. The most important vascular risk factor was hypertension (64.6%). Cognitive evaluation disclosed dementia in 37 (56.9%) subjects. Mean Pfeffer's functional activities questionnaire score was 12.2 points and 22 (33.8%) subjects were impaired in basic activities of daily living. CONCLUSION Parkinsonism was common in this oldest-old population, being associated with dementia and vascular risk factors, particularly hypertension. Different confounders, such as concomitant dementia and exposure to anti-dopaminergic drugs, were present in this population, challenging the definition of causes of parkinsonism.
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Affiliation(s)
- Thiago Cardoso Vale
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Juiz de Fora (MG), Brazil
| | - Maira Tonidandel Barbosa
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil; Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Elisa de Paula França Resende
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil
| | - Débora Palma Maia
- Movement Disorders Unit, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil
| | - Mauro César Quintão Cunningham
- Movement Disorders Unit, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil
| | - Henrique Cerqueira Guimarães
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil
| | | | - Antônio Lucio Teixeira
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil
| | - Francisco Cardoso
- Movement Disorders Unit, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (MG), Brazil.
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Chekani F, Bali V, Aparasu RR. Functional Status of Elderly Nursing Home Residents With Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2017; 6:617-24. [PMID: 27258696 DOI: 10.3233/jpd-160822] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a debilitating neurological disorder that has a significant impact on activities of daily living (ADL). Limited data exists regarding the functional status of nursing home residents with PD. OBJECTIVE The study examined the nature, extent, and predictors of limitation of ADL in patients with PD residing in nursing homes. METHODS This study used cross-sectional design involving data from the National Nursing Home Survey (NNHS). The dependent variable was the total number of ADL for which the patient needed assistance. Assistance for ADL comprised of five items of transferring, dressing, eating, toileting and bathing. Multivariable linear regression was used to examine the individual, biological and environmental factors associated with assistance needed for ADL. RESULTS The nationally representative study sample was of 98,093 nursing home residents with PD for an overall prevalence of 6.57%. The mean age of the study sample was 81.03±0.34 years. Mood symptoms (45%), behavioral symptoms (24%)and dementia (8%) were common among PD patients. Assistance needed for each ADL ranged from 68.24% for eating to 99.25% for bathing. Older age, being married, living in metropolitan statistical area (MSA), living in other place prior to admission, and presence of mood symptoms were positively related to assistance for ADL. Presence of behavioral symptoms and use of levodopa combination therapy were negatively related to assistance for ADL. CONCLUSIONS Majority of the nursing home residents with PD had disability in all the five items of ADL. Various individual, environmental and biological factors were associated with ADL in nursing home residents with PD.
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Affiliation(s)
- Farid Chekani
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, Houston, TX, USA
| | - Vishal Bali
- Senior Health Outcomes Researcher, Health Advocate, Westlake Village, CA, USA
| | - Rajender R Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, Houston, TX, USA
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"Atypical" atypical parkinsonism: Critical appraisal of a cohort. Parkinsonism Relat Disord 2016; 37:36-42. [PMID: 28236526 DOI: 10.1016/j.parkreldis.2016.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/07/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Atypical parkinsonian conditions such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal syndrome (CBS) and Dementia with Lewy bodies (DLB) comprise 10-15% of parkinsonian syndromes. Misdiagnosis with Parkinson disease (PD) and within the entities is common, given the absence of reliable biomarkers. However a correct diagnosis is not only important in clinical practice, but also crucial for any trial attempting to identify biomarkers or new treatments. METHODS Consecutive patients, who were referred to our tertiary center with a diagnosis of a particular AP were included and the medical records were reviewed retrospectively. We applied each set of current diagnostic research criteria to the respective cohort to see which features fit in and if there are any additional atypical features "outside" the classic definition. RESULTS Sixty-nine patients were recruited between January 2013 and May 2015 clinically presenting with one of the following phenotypes: 14 MSA, 24 PSP, 19 CBS and 12 DLB. Up to 49% showed additional "atypical" features and approximately 10% eventually received an alternative diagnosis, in half of whom this being based on genetic testing. CONCLUSIONS In a subset of our patients, despite the final diagnosis of an AP being maintained, there were additional "atypical" features. It remains to be seen if these reflect the clinical heterogeneity of APs, or should prompt a search for an alternative diagnosis. The search for biomarkers is more likely to be successful in homogenous groups of "typical" patients, hence the importance of recognizing "atypical" features.
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Hommel ALAJ, Faber MJ, Weerkamp NJ, van Dijk JG, Bloem BR, Koopmans RT. Prevalence and Prescribed Treatments of Orthostatic Hypotension in Institutionalized Patients with Parkinson’s Disease. JOURNAL OF PARKINSONS DISEASE 2016; 6:805-810. [DOI: 10.3233/jpd-160853] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- ALAJ Hommel
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands, Groenhuysen Organisation, Roosendaal, The Netherlands
| | - MJ Faber
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - NJ Weerkamp
- Department of Neurology, Bronovo Medical Center, The Hague, The Netherlands
| | - JG van Dijk
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - BR Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - RT Koopmans
- Radboud University Medical Center, Department of Primary and Community care, Centre for Family Medicine, Geriatric Care and Public health, Nijmegen, The Netherlands
- Joachim & Anna, Center for Specialized Geriatric Care, Nijmegen
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Schneider R, Dorsey ER, Biglan K. Telemedicine Care for Nursing Home Residents with Parkinsonism. J Am Geriatr Soc 2016; 64:218-20. [DOI: 10.1111/jgs.13909] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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