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Carvalho de Abreu DC, Pieruccini-Faria F, Son S, Montero-Odasso M, Camicioli R. Is white matter hyperintensity burden associated with cognitive and motor impairment in patients with parkinson's disease? A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 161:105677. [PMID: 38636832 DOI: 10.1016/j.neubiorev.2024.105677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/08/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
White matter damage quantified as white matter hyperintensities (WMH) may aggravate cognitive and motor impairments, but whether and how WMH burden impacts these problems in Parkinson's disease (PD) is not fully understood. This study aimed to examine the association between WMH and cognitive and motor performance in PD through a systematic review and meta-analysis. We compared the WMH burden across the cognitive spectrum (cognitively normal, mild cognitive impairment, dementia) in PD including controls. Motor signs were compared in PD with low/negative and high/positive WMH burden. We compared baseline WMH burden of PD who did and did not convert to MCI or dementia. MEDLINE and EMBASE databases were used to conduct the literature search resulting in 50 studies included for data extraction. Increased WMH burden was found in individuals with PD compared with individuals without PD (i.e. control) and across the cognitive spectrum in PD (i.e. PD, PD-MCI, PDD). Individuals with PD with high/positive WMH burden had worse global cognition, executive function, and attention. Similarly, PD with high/positive WMH presented worse motor signs compared with individuals presenting low/negative WMH burden. Only three longitudinal studies were retrieved from our search and they showed that PD who converted to MCI or dementia, did not have significantly higher WMH burden at baseline, although no data was provided on WMH burden changes during the follow up. We conclude, based on cross-sectional studies, that WMH burden appears to increase with PD worse cognitive and motor status in PD.
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Affiliation(s)
- Daniela Cristina Carvalho de Abreu
- Post-doctoral fellow at Gait and Brain Lab, University of Western Ontario, Canada, and Associated Professor of Physiotherapy Course, Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
| | - Frederico Pieruccini-Faria
- Deparment of Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, Lawson Health Research Institute, St. Josephs Health Care, Parkwood Institute, Deputy Director of the Gait & Brain Lab, Canada
| | - Surim Son
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, Statistician, Departments of Medicine, University of Western Ontario, Canada, Parkwood Institute, Lawson Health Research Institute, Canada
| | - Manuel Montero-Odasso
- Departments of Medicine, and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, Canada Director of Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, Canada
| | - Richard Camicioli
- Department of Medicine, Division of Neurology, University of Alberta, Canada
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Xiao Y, Gui Y, Dai J, Zhao H, Rao Z, Luo D, Deng X, Xiao X. Mediation of White Matter Alterations in the Association Between Ventricular Dilation and Cognitive Decline in Hydrocephalus Patients: An MRI Study. J Magn Reson Imaging 2024. [PMID: 38767272 DOI: 10.1002/jmri.29452] [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: 02/05/2024] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Cognitive impairment is commonly observed in hydrocephalus patients. Ventricular enlargement compresses brain parenchyma, especially the white matter (WM). PURPOSE To investigate whether the relationship between ventricular dilation and cognitive decline in hydrocephalus patients is mediated by WM alterations. STUDY TYPE Retrospective. POPULATION 51 communicating hydrocephalus patients (median age, 54 years), 50 obstructive hydrocephalus patients (median age, 49 years), and 53 control subjects (median age, 50 years). FIELD STRENGTH/SEQUENCE Diffusion tensors imaging, 3D T1 BRAVO, 3D FIESTA, CUBE T2, and FLAIR sequences at 3T. ASSESSMENT DTI parameters (skeletonized fractional anisotropy (FA), skeletonized mean diffusivity (MD), and peak width of skeletonized mean diffusivity p(PSMD)) were extracted using FSL software. Global, periventricular, and deep white matter hyperintensity (WMH) volumes, degree of ventricular enlargement (Evans index), and other conventional imaging markers (number of lacunes and perivascular spaces, intracranial and brain volume) were extracted using united imaging intelligence. Cognitive tests included Montreal cognitive assessment (MoCA), clock drawing test (CDT), and vocabulary fluency test (VFT). STATISTICAL TESTS Multivariable linear regression analysis, mediation analyses, and dominance analysis. P-value <0.05 was considered significant. RESULTS The degree of ventricular dilation, DTI parameters, and cognitive function scores were interrelated. The skeletonized FA values (β = -0.0917, 95% confidence interval (CI): -0.205, -0.024) and normalized global WMH volume (β = -0.0635, 95% CI: -0.13, -0.0005) together mediated 37.2% of the association between Evans index and MoCA. A comparable causal pathway was found for periventricular WMHs but not for deep WMHs. Dominance analysis indicated skeletonized FA values had a greater impact on cognition than WMH volume. The skeletonized FA values also mediated the association between Evans index and CDT (β = -0.0897, 95% CI: -0.165, -0.026) and VFT (β = -0.1589, 95% CI: -0.27, -0.083). CONCLUSION WM alterations were causal mediators between ventricular dilation and cognitive decline in hydrocephalus patients. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 3.
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Affiliation(s)
- Yawen Xiao
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yifei Gui
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jiankun Dai
- GE Healthcare, MR Research China, Beijing, China
| | - Heng Zhao
- Department of Radiology, First Affiliated Hospital of University of South China, Hengyang, China
| | - Zhongliang Rao
- Department of Radiology, The Third Hospital of Nanchang, Nanchang, China
| | - Dan Luo
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xinru Deng
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xinlan Xiao
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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Zhang H, Shang J, Li W, Gao D, Zhang J. Increased Expression of VCAM1 on Brain Endothelial Cells Drives Blood-Brain Barrier Impairment Following Chronic Cerebral Hypoperfusion. ACS Chem Neurosci 2024; 15:2028-2041. [PMID: 38710594 PMCID: PMC11099957 DOI: 10.1021/acschemneuro.4c00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024] Open
Abstract
Chronic cerebral hypoperfusion (CCH)-triggered blood-brain barrier (BBB) dysfunction is a core pathological change occurring in vascular dementia (VD). Despite the recent advances in the exploration of the structural basis of BBB impairment and the routes of entry of harmful compounds after a BBB leakage, the molecular mechanisms inducing BBB impairment remain largely unknown in terms of VD. Here, we employed a CCH-induced VD model and discovered increased vascular cell adhesion molecule 1 (VCAM1) expression on the brain endothelial cells (ECs). The expression of VCAM1 was directly correlated with the severity of BBB impairment. Moreover, the VCAM1 expression was associated with different regional white matter lesions. Furthermore, a compound that could block VCAM1 activation, K-7174, was also found to alleviate BBB leakage and protect the white matter integrity, whereas pharmacological manipulation of the BBB leakage did not affect the VCAM1 expression. Thus, our results demonstrated that VCAM1 is an important regulator that leads to BBB dysfunction following CCH. Blocking VCAM1-mediated BBB impairment may thus offer a new strategy to treat CCH-related neurodegenerative diseases.
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Affiliation(s)
- Huiwen Zhang
- Department
of Neurology, Zhengzhou University People’s
Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
| | - Junkui Shang
- Department
of Neurology, Zhengzhou University People’s
Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
| | - Wei Li
- Department
of Neurology, Zhengzhou University People’s
Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
| | - Dandan Gao
- Department
of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430072, China
| | - Jiewen Zhang
- Department
of Neurology, Zhengzhou University People’s
Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China
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Wu H, Hong H, Wu C, Qin J, Zhou C, Tan S, DuanMu X, Guan X, Bai X, Guo T, Wu J, Chen J, Wen J, Cao Z, Gao T, Gu L, Huang P, Xu X, Zhang B, Zhang M. Regional white matter hyperintensity volume in Parkinson's disease and associations with the motor signs. Ann Clin Transl Neurol 2023; 10:1502-1512. [PMID: 37353980 PMCID: PMC10502622 DOI: 10.1002/acn3.51839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE To determine whether white matter hyperintensity (WMH) volumes in specific regions are associated with Parkinson's disease (PD) compared to non-PD controls, and to assess their impact on motor signs through cross-sectional and longitudinal analyses. METHODS A total of 50 PD participants and 47 age- and gender-matched controls were enrolled. All PD participants were followed up for at least 2 years. To detect regions of greater WMH in the PD, the WMH volume of each region was compared with the corresponding region in the control group. Linear regression and linear mixed effects models were respectively used for cross-sectional and longitudinal analyses of the impact of increases in WMH volume on motor signs. RESULTS The PD group had greater WMH volume in the occipital region compared with the control group. Cross-sectional analyses only detected a significant correlation between occipital WMH volume and motor function in PD. Occipital WMH volume positively correlated with the severity of tremor, and gait and posture impairments, in the PD group. During the follow-up period, the participants' motor signs progressed and the WMH volumes remained stable, no longitudinal association was detected between them. The baseline occipital WMH volume cannot predict the progression of signs after adjustment for baseline disease duration and the presence of vascular risk factors. INTERPRETATION PD participants in this study were characterized by greater WMH at the occipital region, and greater occipital WMH volume had cross-sectional associations with worse motor signs, while its longitudinal impact on motor signs progression was limited.
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Affiliation(s)
- Haoting Wu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Hui Hong
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Chenqing Wu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Jianmei Qin
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Cheng Zhou
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Sijia Tan
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Xiaojie DuanMu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Xiaojun Guan
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Xueqin Bai
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Tao Guo
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Jingjing Wu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Jingwen Chen
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Jiaqi Wen
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Zhengye Cao
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Ting Gao
- Department of NeurologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Luyan Gu
- Department of NeurologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Peiyu Huang
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Xiaojun Xu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Baorong Zhang
- Department of NeurologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Minming Zhang
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
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Zhao W, Cheng B, Zhu T, Cui Y, Shen Y, Fu X, Li M, Feng Y, Zhang S. Effects of white matter hyperintensity on cognitive function in PD patients: a meta-analysis. Front Neurol 2023; 14:1203311. [PMID: 37621858 PMCID: PMC10445042 DOI: 10.3389/fneur.2023.1203311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
Background Parkinson's disease (PD) is often accompanied by cognitive dysfunction, which imposes a heavy burden on patients, their families, and society. Early identification and intervention are particularly important, but reliable biomarkers for identifying PD-related cognitive impairment at an early stage are currently lacking. Although numerous clinical studies have investigated the association between brain white matter hyperintensity (WMH) and cognitive decline, the findings regarding the relationships between WMH and cognitive dysfunction in PD patients have been inconsistent. Therefore, this study aims to conduct a meta-analysis of the effect of WMH on PD cognitive function. Methods This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We systematically searched relevant literature from databases such as PubMed, Web of Science, EMBASE, CNKI, and CBM. The retrieval time was limited to database records created up until December 31, 2022. Additionally, we manually retrieved references for full-text reading. Statistical data analysis was performed using RevMan 5.3 and Stata 15.0 software. Results This study encompassed 23 individual studies and involved 2,429 patients with PD. The group of PD with mild cognitive impairment (PD-MCI) exhibited a significantly higher overall level of WMH than the group of PD with normal cognitive function (PD-NC) (SMD = 0.37, 95% CI: 0.21-0.52, p < 0.01). This finding was consistent across subgroup analyses based on different ethnicities (Asian or Caucasian), WMH assessment methods (visual rating scale or volumetry), and age matching. In addition to the overall differences in WMH load between the PD-MCI and PD-NC groups, the study found that specific brain regions, including periventricular white matter hyperintensity (PVH) and deep white matter hyperintensity (DWMH), had significantly higher WMH load in the PD-MCI group compared to the PD-NC group. The study also conducted a meta-analysis of WMH load data for PD with dementia (PDD) and PD without dementia (PDND), revealing that the overall WMH load in the PDD group was significantly higher than that in the PDND group (SMD = 0.98, 95% CI: 0.56-1.41, p < 0.01). This finding was consistent across subgroup analyses based on different ethnicities and age matching. Moreover, regarding specific brain regions (PVH or DWMH), the study found that the PDD group had significantly higher WMH load than the PDND group (p < 0.01). Conclusion WMH was associated with PD cognitive dysfunction. The early appearance of WMH may indicate PD with MCI.
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Affiliation(s)
- Wenhao Zhao
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Bo Cheng
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Tao Zhu
- Department of Preventive Medicine, North Sichuan Medical College, Nanchong, China
| | - Yingjuan Cui
- Department of Nursing, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Yao Shen
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Xudong Fu
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Maogeng Li
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Yuliang Feng
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
| | - Shushan Zhang
- Department of Neurology, Affiliated Hospital of Medical College, North Sichuan Medical College, Nanchong, China
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Ryman SG, Shaff N, Dodd A, Nitschke S, Wertz C, Julio K, Suarez Cedeno G, Deligtisch A, Erhardt E, Lin H, Vakhtin A, Poston KL, Tarawneh R, Pirio Richardson S, Mayer A. Reduced and Delayed Cerebrovascular Reactivity in Patients with Parkinson's Disease. Mov Disord 2023; 38:1262-1272. [PMID: 37157056 PMCID: PMC10524339 DOI: 10.1002/mds.29429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Cerebrovascular dysfunction in Parkinson's disease (PD) is heterogeneous and may contribute to disease pathophysiology or progression. There is a need to understand the mechanisms by which cerebrovascular dysfunction is altered in participants with PD. OBJECTIVES The objective of this study is to test the hypothesis that participants with PD exhibit a significant reduction in the ability of the cerebral vessels to dilate in response to vasoactive challenges relative to healthy controls (HC). METHODS The current study uses a vasodilatory challenge while participants undergo functional magnetic resonance imaging to quantify the amplitude and delay of cerebrovascular reactivity in participants with PD relative to age and sex-matched HC. An analysis of covariance was used to evaluate differences in cerebrovascular reactivity amplitude and latency between PD participants and HC. RESULTS A significant main effect of group was observed for whole-brain cerebrovascular reactivity amplitude (F(1, 28) = 4.38, p = 0.046, Hedge's g = 0.73) and latency (F(1, 28) = 16.35, p < 0.001, Hedge's g = 1.42). Participants with PD exhibited reduced whole-brain amplitude and increased latencies in cerebrovascular reactivity relative to HC. The evaluation of regional effects indicates that the largest effects were observed in the cuneus, precuneus, and parietal regions. CONCLUSIONS PD participants exhibited reduced and delayed cerebrovascular reactivity. This dysfunction may play an important role in chronic hypoxia, neuroinflammation, and protein aggregation, mechanisms that could lead to disease progression. Cerebrovascular reactivity may serve as an important biomarker and target for future interventions. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sephira G Ryman
- Department of Translational Neuroscience, The Mind Research Network, Albuquerque, New Mexico, USA
- Nene and Jamie Koch Comprehensive Movement Disorder Center, Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Nicholas Shaff
- Department of Translational Neuroscience, The Mind Research Network, Albuquerque, New Mexico, USA
| | - Andrew Dodd
- Department of Translational Neuroscience, The Mind Research Network, Albuquerque, New Mexico, USA
| | - Stephanie Nitschke
- Department of Translational Neuroscience, The Mind Research Network, Albuquerque, New Mexico, USA
| | - Christopher Wertz
- Department of Translational Neuroscience, The Mind Research Network, Albuquerque, New Mexico, USA
| | - Kayla Julio
- Department of Translational Neuroscience, The Mind Research Network, Albuquerque, New Mexico, USA
| | - Gerson Suarez Cedeno
- Nene and Jamie Koch Comprehensive Movement Disorder Center, Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Amanda Deligtisch
- Nene and Jamie Koch Comprehensive Movement Disorder Center, Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Henry Lin
- Department of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
- Neurology|Medicine, New Mexico VA Health Care System, Albuquerque, New Mexico, USA
| | - Andrei Vakhtin
- Department of Translational Neuroscience, The Mind Research Network, Albuquerque, New Mexico, USA
| | - Kathleen L Poston
- Movement Disorders Division in the Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Rawan Tarawneh
- Memory and Aging Center, Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Sarah Pirio Richardson
- Nene and Jamie Koch Comprehensive Movement Disorder Center, Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
- Neurology|Medicine, New Mexico VA Health Care System, Albuquerque, New Mexico, USA
| | - Andrew Mayer
- Department of Translational Neuroscience, The Mind Research Network, Albuquerque, New Mexico, USA
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Ruan Z, Sun D, Zhou X, Yu M, Li S, Sun W, Li Y, Gao L, Xu H. Altered neurovascular coupling in patients with vascular cognitive impairment: a combined ASL-fMRI analysis. Front Aging Neurosci 2023; 15:1224525. [PMID: 37416325 PMCID: PMC10320594 DOI: 10.3389/fnagi.2023.1224525] [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: 05/17/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
Background and objective This study aims to examine the role of neurovascular coupling (NVC) in vascular cognitive impairment (VCI) by investigating the relationship between white matter lesion (WML) burden, NVC, and cognitive deficits. Additionally, we aim to explore the potential of NVC as a tool for understanding the neural mechanisms underlying VCI. Methods This study included thirty-eight small vessel disease cognitive impairment (SVCI) patients, 34 post-stroke cognitive impairment (PSCI) patients, and 43 healthy controls (HC). Comprehensive assessments, including neuroimaging and neuropsychological testing, were conducted to evaluate cognitive function. WML burden was measured and correlated with NVC coefficients to examine the relationship between white matter pathology and NVC. Mediation analysis was employed to explore the link relationship between NVC, WML burden, and cognitive function. Results The present study showed that NVC was significantly reduced in the SVCI and PSCI groups compared with HCs at both whole-brain and brain region level. The analysis revealed notable findings regarding NVC in relation to WML burden and cognitive function in VCI patients. Specifically, reduced NVC coefficients were observed within higher order brain systems responsible for cognitive control and emotion regulation. Mediation analysis demonstrated that NVC played a mediating role in the relationship between WML burden and cognitive impairment. Conclusion This study reveals the mediating role of NVC in the relationship between WML burden and cognitive function in VCI patients. The results demonstrate the potential of the NVC as an accurate measure of cognitive impairment and its ability to identify specific neural circuits affected by WML burden.
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Affiliation(s)
- Zhao Ruan
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Dong Sun
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaoli Zhou
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Minhua Yu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Sirui Li
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Wenbo Sun
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yidan Li
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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8
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Carvalho de Abreu DC, Pieruccini-Faria F, Sarquis-Adamson Y, Black A, Fraser J, Van Ooteghem K, Cornish B, Grimes D, Jog M, Masellis M, Steeves T, Nanayakkara N, Ramirez J, Scott C, Holmes M, Ozzoude M, Berezuk C, Symons S, Mohammad Hassan Haddad S, Arnott SR, Binns M, Strother S, Beaton D, Sunderland K, Theyers A, Tan B, Zamyadi M, Levine B, Orange JB, Roberts AC, Lou W, Sujanthan S, Breen DP, Marras C, Kwan D, Adamo S, Peltsch A, Troyer AK, Black SE, McLaughlin PM, Lang AE, McIlroy W, Bartha R, Montero-Odasso M. White matter hyperintensity burden predicts cognitive but not motor decline in Parkinson's disease: results from the Ontario Neurodegenerative Diseases Research Initiative. Eur J Neurol 2023; 30:920-933. [PMID: 36692250 DOI: 10.1111/ene.15692] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE The pathophysiology of Parkinson's disease (PD) negatively affects brain network connectivity, and in the presence of brain white matter hyperintensities (WMHs) cognitive and motor impairments seem to be aggravated. However, the role of WMHs in predicting accelerating symptom worsening remains controversial. The objective was to investigate whether location and segmental brain WMH burden at baseline predict cognitive and motor declines in PD after 2 years. METHODS Ninety-eight older adults followed longitudinally from Ontario Neurodegenerative Diseases Research Initiative with PD of 3-8 years in duration were included. Percentages of WMH volumes at baseline were calculated by location (deep and periventricular) and by brain region (frontal, temporal, parietal, occipital lobes and basal ganglia + thalamus). Cognitive and motor changes were assessed from baseline to 2-year follow-up. Specifically, global cognition, attention, executive function, memory, visuospatial abilities and language were assessed as were motor symptoms evaluated using the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III, spatial-temporal gait variables, Freezing of Gait Questionnaire and Activities Specific Balance Confidence Scale. RESULTS Regression analysis adjusted for potential confounders showed that total and periventricular WMHs at baseline predicted decline in global cognition (p < 0.05). Also, total WMH burden predicted the decline of executive function (p < 0.05). Occipital WMH volumes also predicted decline in global cognition, visuomotor attention and visuospatial memory declines (p < 0.05). WMH volumes at baseline did not predict motor decline. CONCLUSION White matter hyperintensity burden at baseline predicted cognitive but not motor decline in early to mid-stage PD. The motor decline observed after 2 years in these older adults with PD is probably related to the primary neurodegenerative process than comorbid white matter pathology.
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Affiliation(s)
- Daniela Cristina Carvalho de Abreu
- Gait and Brain Lab, Division of Geriatric Medicine, and Lawson Health Research Institute, Parkwood Institute, University of Western Ontario, Ontario, London, Canada
- Department of Physical Therapy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Frederico Pieruccini-Faria
- Gait and Brain Lab, Division of Geriatric Medicine, and Lawson Health Research Institute, Parkwood Institute, University of Western Ontario, Ontario, London, Canada
- Gait and Brain Laboratory, Lawson Health Research Institute, London, Ontario, Canada
| | | | - Alanna Black
- Gait and Brain Laboratory, Lawson Health Research Institute, London, Ontario, Canada
| | - Julia Fraser
- Neuroscience, Mobility and Balance Laboratory, Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Karen Van Ooteghem
- Neuroscience, Mobility and Balance Laboratory, Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Benjamin Cornish
- Neuroscience, Mobility and Balance Laboratory, Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - David Grimes
- Department of Medicine (Neurology), Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
| | - Mandar Jog
- Division of Neurology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mario Masellis
- Cognitive and Movement Disorders Clinic, Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Department of Medicine (Neurology), Sunnybrook Research Institute, Sunnybrook HSC, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Steeves
- Division of Neurology, Department of Medicine, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Nuwan Nanayakkara
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Joel Ramirez
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Department of Medicine (Neurology), Sunnybrook Research Institute, Sunnybrook HSC, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Scott
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Department of Medicine (Neurology), Sunnybrook Research Institute, Sunnybrook HSC, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Holmes
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Department of Medicine (Neurology), Sunnybrook Research Institute, Sunnybrook HSC, University of Toronto, Toronto, Ontario, Canada
| | - Miracle Ozzoude
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Department of Medicine (Neurology), Sunnybrook Research Institute, Sunnybrook HSC, University of Toronto, Toronto, Ontario, Canada
| | - Courtney Berezuk
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Department of Medicine (Neurology), Sunnybrook Research Institute, Sunnybrook HSC, University of Toronto, Toronto, Ontario, Canada
| | - Sean Symons
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Department of Medicine (Neurology), Sunnybrook Research Institute, Sunnybrook HSC, University of Toronto, Toronto, Ontario, Canada
| | | | - Stephen R Arnott
- Rotman Research Institute at Baycrest Hospital University of Toronto, Toronto, Ontario, Canada
| | - Malcolm Binns
- Rotman Research Institute at Baycrest Hospital University of Toronto, Toronto, Ontario, Canada
| | - Stephen Strother
- Rotman Research Institute at Baycrest Hospital University of Toronto, Toronto, Ontario, Canada
| | - Derek Beaton
- Rotman Research Institute at Baycrest Hospital University of Toronto, Toronto, Ontario, Canada
| | - Kelly Sunderland
- Rotman Research Institute at Baycrest Hospital University of Toronto, Toronto, Ontario, Canada
| | - Athena Theyers
- Rotman Research Institute at Baycrest Hospital University of Toronto, Toronto, Ontario, Canada
| | - Brian Tan
- Rotman Research Institute at Baycrest Hospital University of Toronto, Toronto, Ontario, Canada
| | - Mojdeh Zamyadi
- Rotman Research Institute at Baycrest Hospital University of Toronto, Toronto, Ontario, Canada
| | - Brian Levine
- Rotman Research Institute at Baycrest Hospital University of Toronto, Toronto, Ontario, Canada
| | - Joseph B Orange
- School of Communication Sciences and Disorders, Faculty of Health Sciences, Canadian Centre for Activity and Aging, Western University, London, Ontario, Canada
| | - Angela C Roberts
- School of Communication Sciences and Disorders, Faculty of Health Sciences, Canadian Centre for Activity and Aging, Western University, London, Ontario, Canada
- Department of Computer Science, Western University, London, Ontario, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sujeevini Sujanthan
- Department of Ophthalmology and Visual Sciences, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - David P Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Connie Marras
- Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Donna Kwan
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Sabrina Adamo
- Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Alicia Peltsch
- Faculty of Engineering and Applied Science, Queen's University, Kingston, Ontario, Canada
| | - Angela K Troyer
- Neuropsychology and Cognitive Health Program, Baycrest Health Sciences, Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Program, Department of Medicine (Neurology), Sunnybrook Research Institute, Sunnybrook HSC, University of Toronto, Toronto, Ontario, Canada
| | | | - Anthony E Lang
- Division of Neurology, Department of Medicine, Edmond J Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - William McIlroy
- Neuroscience, Mobility and Balance Laboratory, Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Robert Bartha
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Robarts Research Institute, Western University, London, Canada
| | | | - Manuel Montero-Odasso
- Gait and Brain Lab, Division of Geriatric Medicine, and Lawson Health Research Institute, Parkwood Institute, University of Western Ontario, Ontario, London, Canada
- Gait and Brain Laboratory, Lawson Health Research Institute, London, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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9
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Tzeng RC, Yang YW, Hsu KC, Chang HT, Chiu PY. Sum of boxes of the clinical dementia rating scale highly predicts conversion or reversion in predementia stages. Front Aging Neurosci 2022; 14:1021792. [PMID: 36212036 PMCID: PMC9537043 DOI: 10.3389/fnagi.2022.1021792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background The clinical dementia rating (CDR) scale is commonly used to diagnose dementia due to Alzheimer's disease (AD). The sum of boxes of the CDR (CDR-SB) has recently been emphasized and applied to interventional trials for tracing the progression of cognitive impairment (CI) in the early stages of AD. We aimed to study the influence of baseline CDR-SB on disease progression to dementia or reversion to normal cognition (NC). Materials and methods The baseline CDR < 1 cohort registered from September 2015 to August 2020 with longitudinal follow-up in the History-based Artificial Intelligence Clinical Dementia Diagnostic System (HAICDDS) database was retrospectively analyzed for the rates of conversion to CDR ≥ 1. A Cox regression model was applied to study the influence of CDR-SB levels on progression, adjusting for age, education, sex, neuropsychological tests, neuropsychiatric symptoms, parkinsonism, and multiple vascular risk factors. Results A total of 1,827 participants were analyzed, including 1,258 (68.9%) non-converters, and 569 (31.1%) converters with mean follow-up of 2.1 (range 0.4-5.5) and 1.8 (range 0.3-5.0) years, respectively. Conversion rates increased with increasing CDR-SB scores. Compared to a CDR-SB score of 0, the hazard ratios (HR) for conversion to dementia were 1.51, 1.91, 2.58, 2.13, 3.46, 3.85, 3.19, 5.12, and 5.22 for CDR-SB scores of 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, and ≥4.5, respectively (all p < 0.05 except for CDR-SB score = 0.5). In addition, older age, lower education, lower cognitive performance, and a history of diabetes also increased conversion rates. Furthermore, reversions to NC were 12.5, 5.6, 0.9, and 0% for CDR-SB scores of 0.5, 1.0-2.0, 2.5-3.5 and ≥4.0, respectively (p < 0.001). Conclusion CDR-SB in predementia or very mild dementia (VMD) stages highly predicts progression to dementia or reversion to NC. Therefore, CDR-SB could be a good candidate for tracing the effectiveness of pharmacological and non-pharmacological interventions in populations without dementia.
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Affiliation(s)
- Ray-Chang Tzeng
- Department of Neurology, Tainan Municipal Hospital, Tainan, Taiwan
| | - Yu-Wan Yang
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Kai-Cheng Hsu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, China Medical University, Taichung, Taiwan
- Artificial Intelligence Center for Medical Diagnosis, China Medical University Hospital, Taichung, Taiwan
| | - Hsin-Te Chang
- Department of Psychology, College of Science, Chung Yuan Christian University, Taoyuan City, Taiwan
| | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Applied Mathematics, Tunghai University, Taichung, Taiwan
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10
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Tanaka R, Hattori N. Abnormal circadian blood pressure regulation and cognitive impairment in α-synucleinopathies. Hypertens Res 2022; 45:1908-1917. [PMID: 36123397 DOI: 10.1038/s41440-022-01032-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/08/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022]
Abstract
Circadian blood pressure (BP) rhythm is important for the maintenance of healthy daily life, and its disruption is associated with poor outcomes. Cardiovascular autonomic failure is often observed in older populations but has a greater impact on neurodegenerative disorders such as α-synucleinopathies. These BP abnormalities include orthostatic hypotension (OH), supine hypertension (SH), and a loss of nocturnal BP fall. OH not only causes falls or syncope but is also related to cognitive impairment in α-synucleinopathies. For example, OH doubles or triples the risk for the development of cognitive impairment in Parkinson's disease (PD). The diffuse central and peripheral neuropathology of α-synuclein may contribute to both OH and cognitive impairment. Moreover, repeated cerebral hypoperfusion in OH is thought to be related to cerebrovascular and neuronal damage, which may cause cognitive impairment. SH, which often coexists with OH, is also associated with cognitive impairment through cerebrovascular damage, such as white matter lesions and cerebral microbleeds. The reverse-dipping (riser) pattern on ambulatory BP monitoring is commonly observed in PD (∼56%), regardless of disease duration and severity. It is also related to cognitive impairment and more pronounced when coexisting with OH. These abnormal circadian BP profiles may be synergistically associated with cognitive impairment and poor outcomes in α-synucleinopathies. Although evidence for aggressive control of BP dysregulation improving cognitive impairment and outcomes is limited, regular BP monitoring appears to be important for total management of α-synucleinopathies.
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Affiliation(s)
- Ryota Tanaka
- Stroke Center and Division of Neurology, Department of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Hongo 3311-1, Bunkyo-ku, Tokyo, 113-0011, Japan
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11
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Chen TY, Chan PC, Tsai CF, Wei CY, Chiu PY. White matter hyperintensities in dementia with Lewy bodies are associated with poorer cognitive function and higher dementia stages. Front Aging Neurosci 2022; 14:935652. [PMID: 36092817 PMCID: PMC9459160 DOI: 10.3389/fnagi.2022.935652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose White matter hyperintensities (WMHs) are frequently found in elderly individuals with or without dementia. However, the association between WMHs and clinical presentations of dementia with Lewy bodies (DLB) has rarely been studied. Methods We conducted a retrospective analysis of patients with DLB registered in a dementia database. WMHs were rated visually using the Fazekas scale, and its associated factors including dementia severity, cognitive functions, neuropsychiatric symptoms, and core clinical features were compared among different Fazekas scores. Domains in the Clinical Dementia Rating (CDR), Cognitive abilities Screening Instruments (CASI), and Neuropsychiatric Inventory (NPI) were compared among different Fazekas groups after adjusting for age, sex, education, and disease duration. Results Among the 449 patients, 76, 207, 110, and 56 had Fazekas score of 0, 1, 2, and 3, respectively. There was a positive association between dementia severity and WMHs severity, and the mean sums of boxes of the Clinical Dementia Rating (CDR-SB) were 5.9, 7.8, 9.5, and 11.2 (f = 16.84, p < 0.001) for the Fazekas scale scores 0, 1, 2, and 3, respectively. There was a negative association between cognitive performance and WMHs severity, and the mean CASI were 57.7, 45.4, 4.06, and 33.4 (f = 14.22, p < 0.001) for the Fazekas scale scores 0, 1, 2, and 3, respectively. However, WMHs were not associated with the core clinical features of DLB. After adjustment, all cognitive domains in CDR increased as the Fazekas score increased. In addition, performance on all cognitive domains in CASI decreased as the Fazekas score increased (all p < 0.001). Among neuropsychiatric symptoms, delusions, euphoria, apathy, aberrant motor behavior, and sleep disorders were significantly worse in the higher Fazekas groups compared to those in the group with Fazekas score of 0 after adjustment. Conclusion WMHs in DLB might contribute to deterioration of cognitive function, neuropsychiatric symptoms, and dementia stages. However, core clinical features were not significantly influenced by WMHs in DLB.
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Affiliation(s)
- Tai-Yi Chen
- Department of Radiology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Po-Chi Chan
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ching-Fang Tsai
- Tainan Sin-Lau Hospital, The Presbyterian Church in Taiwan, Tainan, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Applied Mathematics, Tunghai University, Taichung, Taiwan
- *Correspondence: Pai-Yi Chiu,
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12
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Grey MT, Mitterová K, Gajdoš M, Uher R, Klobušiaková P, Rektorová I, Rektor I. Differential spatial distribution of white matter lesions in Parkinson's and Alzheimer's diseases and cognitive sequelae. J Neural Transm (Vienna) 2022; 129:1023-1030. [PMID: 35819634 DOI: 10.1007/s00702-022-02519-z] [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: 03/03/2022] [Accepted: 05/20/2022] [Indexed: 10/17/2022]
Abstract
White Matter Lesions (WML) are a radiological finding common in aged subjects. We explored the impact of WML on underlying neurodegenerative processes. We focused on the impact of WML on two neurodegenerative diseases with different pathology. In this cross-sectional study of 137 subjects (78 female, 59 men, mean age 67.2; 43-87 years), we compared WML in healthy controls (HC; n = 55), patients with Alzheimer's disease and amnestic Mild Cognitive Impairment (aMCI), and Parkinson's disease patients with normal cognition and with MCI. Subjects with AD and aMCI were treated as one group (n = 40), subjects with PD and PDMCI were another group (n = 42). MRI T2_FLAIR sequences were analyzed. WML were divided into periventricular (pWML) or subcortical (sWML) depending on their distance from the ventricles. Subjects from the AD + aMCI group, had a significantly greater volume of WML than both HC and the PD + PDMCI group. The volume of WML was greater in the PD + PDMCI than in HC but the difference was not significant. In AD + aMCI subjects, sWML and not pWML were related to a decrease in global cognitive functioning despite greater volume of pWML. In PD + PDMCI, pWML correlate with decline in executive functions and working memory. In HC, pWML correlated with the multidomain decrease corresponding with the aging. This points to a difference between normal aging and pathological aging due to AD and PD brain pathology. The WML location together with underlying disease related neurodegeneration may play a role in determining the effect of WML on cognition. Our results suggest that the impact of WML is not uniform in all patients; rather, their volume, location and cognitive effect may be disease-specific.
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Affiliation(s)
- Michael T Grey
- Central European Institute of Technology (CEITEC), Brain and Mind Research Program, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.,First Department of Neurology, St. Anne's Hospital, School of Medicine, Masaryk University, Pekařská, 602 00, Brno, Czech Republic
| | - Kristína Mitterová
- Central European Institute of Technology (CEITEC), Brain and Mind Research Program, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.,First Department of Neurology, St. Anne's Hospital, School of Medicine, Masaryk University, Pekařská, 602 00, Brno, Czech Republic
| | - Martin Gajdoš
- Central European Institute of Technology (CEITEC), Brain and Mind Research Program, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Richard Uher
- Central European Institute of Technology (CEITEC), Brain and Mind Research Program, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Patrícia Klobušiaková
- Central European Institute of Technology (CEITEC), Brain and Mind Research Program, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Irena Rektorová
- Central European Institute of Technology (CEITEC), Brain and Mind Research Program, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.,First Department of Neurology, St. Anne's Hospital, School of Medicine, Masaryk University, Pekařská, 602 00, Brno, Czech Republic
| | - Ivan Rektor
- Central European Institute of Technology (CEITEC), Brain and Mind Research Program, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic. .,First Department of Neurology, St. Anne's Hospital, School of Medicine, Masaryk University, Pekařská, 602 00, Brno, Czech Republic. .,Masaryk University, CEITEC Neuroscience Center and First Department of Neurology, St. Anne's University Hospital, Pekařská 53, 656 91, Brno, Czech Republic.
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13
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Meira B, Fernandes M, Salavisa M, Saraiva M, Conceição L, Borbinha C, Ladeira F, Marto JP, Barbosa R, Mendonça M, Bugalho P. Obstructive Sleep Apnea and Other Vascular Risk factors' Impact on Non‐Motor Symptoms in Parkinson's Disease. Mov Disord Clin Pract 2022; 9:785-798. [DOI: 10.1002/mdc3.13504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/16/2022] [Accepted: 05/22/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Bruna Meira
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Marco Fernandes
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Manuel Salavisa
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Marlene Saraiva
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Laurete Conceição
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Cláudia Borbinha
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - Filipa Ladeira
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
| | - João Pedro Marto
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
- NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Raquel Barbosa
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
- NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Marcelo Mendonça
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
- NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
- Champalimaud Research and Clinical Centre Champalimaud Foundation Lisbon Portugal
| | - Paulo Bugalho
- Neurology Department, Hospital Egas Moniz Centro Hospitalar de Lisboa Ocidental Lisbon Portugal
- NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
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14
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Chung CM, Chan PC, Wei CY, Hung GU, Tzeng RC, Chiu PY. Emergency department visits among people with predementia highly predicts conversion to dementia. PLoS One 2022; 17:e0270284. [PMID: 35749416 PMCID: PMC9231782 DOI: 10.1371/journal.pone.0270284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
Emergency department visits (EDV) are common among older adults with and without dementia. The risk factors and demands of EDVs for people with dementia have been well studied; however, the association between EDVs and conversion to dementia among people with predementia has not been thoroughly explored. To study the predictive value of EDVs in predementia's progression to dementia. The baseline predementia cohort registered from September 2015 to August 2017, with longitudinal follow-up in the History-based Artificial Intelligent Clinical Dementia Diagnostic System database, was retrospectively analyzed. The rates of conversion among the different EDVs were compared. Multivariate logistic regression and Cox proportional hazards analyses were applied to study the influence of EDVs on progression. Age, education, sex, neuropsychological tests, activities of daily living, neuropsychiatric symptoms, parkinsonism, and multiple vascular risk factors were adjusted for. A total of 512 participants were analyzed, including 339 (66.2%) non-converters and 173 (33.8%) converters with a mean follow-up of 3.3 (range 0.4-6.1) and 2.8 (range 0.5-5.9) years, respectively. Compared to people without EDV (EDV 0), the hazard ratios for conversion to dementia were 3.6, 5.9, and 6.9 in those with EDV once (EDV 1), twice (EDV 2), and more than twice (EDV >2), respectively. In addition, older age, lower education, poorer cognition, poorer ADL performance, and longer follow-up periods also increased the conversion rates. EDVs in the predementia stages highly predict progression to dementia. Therefore, a sound public health as well as primary healthcare system that provide strategies for better management of mental and physical condition might help prevention of EDVs among older people in the predementia stages.
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Affiliation(s)
- Chia-Min Chung
- Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Po-Chi Chan
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ray-Chang Tzeng
- Department of Neurology, Tainan Municipal Hospital, Tainan, Taiwan
| | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Applied Mathematics, Tunghai University, Taichung, Taiwan
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15
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Affective disorders and сognitive impairment in the early stages of Parkinson's disease. КЛИНИЧЕСКАЯ ПРАКТИКА 2022. [DOI: 10.17816/clinpract100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Parkinson's disease (BP) is the second most important age-related neurodegenerative disease in developed societies after Alzheimer's disease with a prevalence of 41 per 100,000 in the fourth decade of life to more than 1900 per 100,000 people over 80 years old.
Parkinson's disease (BP) is the second most important age-related neidgenerative disease in developed societies after Alzheimer's disease with a prevalence of 41 per 100,000 in the fourth decade of life to more than 1900 per 100,000 people over 80 years old.
Neurodegeneration associated with Parkinson's disease is likely to occur over several decades before the appearance of motor symptoms.
Affective and cognitive some of the most frequent non-engine manifestations of BP diseases that can lead to a variety of adverse outcomes
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16
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Zhang M, Chen H, Liu G, Wang X, Wang Z, Feng T, Zhang Y. Correlation Between Lacunae and the Wearing-off Phenomenon in Parkinson's Disease. Neuropsychiatr Dis Treat 2022; 18:67-74. [PMID: 35046657 PMCID: PMC8760975 DOI: 10.2147/ndt.s342688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/26/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Lacunae are imaging biomarkers of cerebral small vessel disease (CSVD) and are correlated with the degree of gait instability in Parkinson's disease (PD). The wearing-off phenomenon (WO) occurs more frequently in PD patients as disease progresses. The present study aimed to investigate the overall impact of the quantity and location of lacunae on the WO in PD. PATIENTS AND METHODS This retrospective, single-center study included 315 consecutive eligible patients with PD from Beijing Tiantan Hospital from May 2016 to August 2018. We collected data on demographics and clinical features, assessed lacunae and examined the presence of the WO. The association between lacunae and the WO was assessed using a binary logistic regression model. RESULTS The number of lacunae was significantly associated with the WO in patients with PD according to a model adjusted for age at onset, disease duration, Hoehn-Yahr (H-Y) staging, Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III) total score and levodopa equivalent daily dosage (LEED) (P=0.037, OR 1.156, 95% CI 1.009, 1.325) and to a model further adjusted for other CSVD imaging biomarkers (P=0.046, OR 1.172, 95% CI 1.003, 1.369). Following additional adjustment for other potential confounders, the association remained significant (P=0.043, OR 1.195, 95% CI 1.005, 1.421). Lacunae in subcortical areas (P=0.004, OR 0.498, 95% CI 0.308, 0.803) and basal ganglia (P=0.046, OR 1.616, 95% CI 1.009, 2.587), especially in the caudate nuclei (P=0.023, OR 1.104, 95% CI 0.185, 0.881), were significantly associated with the WO in PD patients. CONCLUSION Our finding highlights the significant association between lacune and the WO, and lacunae may be an independent contributor to the WO in PD patients. Promoting neurovascular health may prevent the progression of the WO in PD patients.
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Affiliation(s)
- Meimei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, People's Republic of China
| | - Huimin Chen
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Genliang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, People's Republic of China
| | - Xuemei Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, People's Republic of China
| | - Zhan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, People's Republic of China
| | - Tao Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, People's Republic of China
| | - Yumei Zhang
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, People's Republic of China.,Department of Rehabilitation, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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17
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Narasimhan M, Schwartz R, Halliday G. Parkinsonism and cerebrovascular disease. J Neurol Sci 2021; 433:120011. [PMID: 34686356 DOI: 10.1016/j.jns.2021.120011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/01/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
The relationship between cerebrovascular disease and parkinsonism is commonly seen in everyday clinical practice but remains ill-defined and under-recognised with little guidance for the practising neurologist. We attempt to define this association and to illustrate key clinical, radiological and pathological features of the syndrome of Vascular Parkinsonism (VaP). VaP is a major cause of morbidity in the elderly associated with falls, hip fractures and cognitive impairment. Although acute parkinsonism is reported in the context of an acute cerebrovascular event, the vast majority of VaP presents as an insidious syndrome usually in the context of vascular risk factors and radiological evidence of small vessel disease. There may be an anatomic impact on basal ganglia neuronal networks, however the effect of small vessel disease (SVD) on these pathways is not clear. There are now established reporting standards for radiological features of SVD on MRI. White matter hyperintensities and lacunes have been thought to be the representative radiological features of SVD but other features such as the perivascular space are gaining more importance, especially in context of the glymphatic system. It is important to consider VaP in the differential diagnosis of Parkinson disease (PD) and in these situations, neuroimaging may offer diagnostic benefit especially in those patients with atypical presentations or refractoriness to levodopa. Proactive management of vascular risk factors, monitoring of bone density and an exercise program may offer easily attainable therapeutic targets in PD and VaP. Levodopa therapy should be considered in patients with VaP, however the dose and effect may be different from use in PD. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Manisha Narasimhan
- Brain and Mind Centre and Faculty of Health and Medical Sciences, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia.
| | - Raymond Schwartz
- Brain and Mind Centre and Faculty of Health and Medical Sciences, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Glenda Halliday
- Brain and Mind Centre and Faculty of Health and Medical Sciences, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
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Liu H, Deng B, Xie F, Yang X, Xie Z, Chen Y, Yang Z, Huang X, Zhu S, Wang Q. The influence of white matter hyperintensity on cognitive impairment in Parkinson's disease. Ann Clin Transl Neurol 2021; 8:1917-1934. [PMID: 34310081 PMCID: PMC8419402 DOI: 10.1002/acn3.51429] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/05/2021] [Accepted: 07/02/2021] [Indexed: 01/11/2023] Open
Abstract
The aim of this meta‐analysis was to review systematically and to identify the relationship between the severity and location of white matter hyperintensities (WMHs) and the degree of cognitive decline in patients with Parkinson’s disease (PD). We searched the PubMed, EMBASE, Web of Science, Ovid, and Cochrane Library databases for clinical trials of the severity and location of WMHs on the degree of cognitive impairment in PD through October 2020. We conducted the survey to compare the association of WMH burden in patients with PD with mild cognitive impairment (PD‐MCI) versus those with normal cognition (PD‐NC) and in patients with PD with dementia (PDD) versus those with PD without dementia (PD‐ND). Nine studies with PD‐MCI versus PD‐NC and 10 studies with PDD versus PD‐ND comparisons were included. The WMH burden in PD‐MCI patients was significantly different compared to that in PD‐NC patients (standard mean difference, SMD = 0.39, 95% CI: 0.12 to 0.66, p = 0.005), while there was no correlation shown in the age‐matched subgroup of the comparison. In addition, PDD patients had a significantly higher burden of WMHs (SMD = 0.8, 95% CI: 0.44 to 1.71, p < 0.0001), especially deep white matter hyperintensities (SMD = 0.54, 95% CI: 0.36 to 0.73, p < 0.00001) and periventricular hyperintensities (SMD = 0.70, 95% CI: 0.36 to 1.04, p < 0.0001), than PD‐NC patients, regardless of the adjustment of age. WMHs might be imaging markers for cognitive impairment in PDD but not in PD‐MCI, regardless of age, vascular risk factors, or race. Further prospective studies are needed to validate the conclusions.
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Affiliation(s)
- Hailing Liu
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China.,Department of Neurology, Maoming People's Hospital, Maoming, Guangdong, China
| | - Bin Deng
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Fen Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Xiaohua Yang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Zhenchao Xie
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Yonghua Chen
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Zhi Yang
- Department of Neurology, Maoming People's Hospital, Maoming, Guangdong, China
| | - Xiyan Huang
- Department of Rehabilitation, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Shuzhen Zhu
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, P.R. China
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Fang E, Fartaria MJ, Ann CN, Maréchal B, Kober T, Lim JX, Ooi LQR, Chen C, Lim SL, Tan EK, Chan LL. Clinical correlates of white matter lesions in Parkinson's disease using automated multi-modal segmentation measures. J Neurol Sci 2021; 427:117518. [PMID: 34118693 DOI: 10.1016/j.jns.2021.117518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 05/28/2021] [Accepted: 05/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Age-related white matter lesions (WML) are common, impact neuronal connectivity, and affect motor function and cognition. In addition to pathological nigrostriatal losses, WML are also common co-morbidities in Parkinson's disease (PD) that affect postural stability and gait. Automated brain volume measures are increasingly incorporated into the clinical reporting workflow to facilitate precision in medicine. Recently, multi-modal segmentation algorithms have been developed to overcome challenges with WML quantification based on single-modality input. OBJECTIVE We evaluated WML volumes and their distribution in a case-control cohort of PD patients to predict the domain-specific clinical severity using a fully automated multi-modal segmentation algorithm. METHODS Fifty-five subjects comprising of twenty PD patients and thirty-five age- and gender-matched control subjects underwent standardized motor/gait and cognitive assessments and brain MRI. Spatially differentiated WML obtained using automated segmentation algorithms on multi-modal MPRAGE and FLAIR images were used to predict domain-specific clinical severity. Preliminary statistical analysis focused on describing the relationship between WML and clinical scores, and the distribution of WML by brain regions. Subsequent stepwise regressions were performed to predict each clinical score using WML volumes in different brain regions, while controlling for age. RESULTS WML volume strongly correlates with both motor and cognitive dysfunctions in PD patients (p < 0.05), with differential impact in the frontal lobe and periventricular regions on cognitive domains (p < 0.01) and severity of motor deficits (p < 0.01), respectively. CONCLUSION Automated multi-modal segmentation algorithms may facilitate precision medicine through regional WML load quantification, which show potential as imaging biomarkers for predicting domain-specific disease severity in PD.
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Affiliation(s)
- Eric Fang
- Singapore General Hospital, Singapore
| | - Mário João Fartaria
- Advanced Clinical Imaging Technology, Siemens Healthcare AG (HC CMEA SUI DI BM PI), Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | | | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthcare AG (HC CMEA SUI DI BM PI), Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG (HC CMEA SUI DI BM PI), Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | | | | | | | | | - Eng King Tan
- National Neuroscience Institute, Singapore; Duke-NUS Medical School, Singapore
| | - Ling Ling Chan
- Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
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Paolini Paoletti F, Simoni S, Parnetti L, Gaetani L. The Contribution of Small Vessel Disease to Neurodegeneration: Focus on Alzheimer's Disease, Parkinson's Disease and Multiple Sclerosis. Int J Mol Sci 2021; 22:ijms22094958. [PMID: 34066951 PMCID: PMC8125719 DOI: 10.3390/ijms22094958] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 01/18/2023] Open
Abstract
Brain small vessel disease (SVD) refers to a variety of structural and functional changes affecting small arteries and micro vessels, and manifesting as white matter changes, microbleeds and lacunar infarcts. Growing evidence indicates that SVD might play a significant role in the neurobiology of central nervous system (CNS) neurodegenerative disorders, namely Alzheimer's disease (AD) and Parkinson's disease (PD), and neuroinflammatory diseases, such as multiple sclerosis (MS). These disorders share different pathophysiological pathways and molecular mechanisms (i.e., protein misfolding, derangement of cellular clearance systems, mitochondrial impairment and immune system activation) having neurodegeneration as biological outcome. In these diseases, the actual contribution of SVD to the clinical picture, and its impact on response to pharmacological treatments, is not known yet. Due to the high frequency of SVD in adult-aged patients, it is important to address this issue. In this review, we report preclinical and clinical data on the impact of SVD in AD, PD and MS, with the main aim of clarifying the predictability of SVD on clinical manifestations and treatment response.
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21
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Meléndez-Flores JD, Cavazos-Benítez AC, Estrada-Bellmann I. Microalbuminuria as a potential biomarker for Parkinson's disease severity: A hypothesis. Med Hypotheses 2021; 149:110510. [PMID: 33609950 DOI: 10.1016/j.mehy.2021.110510] [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: 12/22/2020] [Accepted: 01/22/2021] [Indexed: 11/27/2022]
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative condition characterized by motor and non-motor symptoms causing a great burden in patients' quality of life. PD has been associated with various metabolic factors such as diabetes, hypertension, and more recently chronic kidney disease where proteinuria has been associated with an increased risk. The presence of small amounts of albumin in urine, microalbuminuria, is a common biomarker for endothelial damage and a predictive factor for not only cardiovascular but also neurological dysfunction. Multiple studies have assessed potential biomarkers for PD progression with great heterogeneity, we hypothesize the use of microalbuminuria as a potential marker that correlates with PD severity and might represent a feasible and simple method of evaluating PD patients in clinical practice. Evidence supporting the present hypothesis comes from oxidative stress, insulin resistance, and endothelial dysfunction. Oxidative stress is a key element in PD pathogenesis; studies have shown lower antioxidant capacity as PD progresses. On the other side, insulin signaling plays an important role in neuronal growth and survival, with its resistance being associated with PD. Microalbuminuria has been associated with both processes; increased levels of oxidative stress markers and decreased insulin sensitivity, hence its screening in PD might reflect these common pathological mechanisms. Moreover, the low vitamin D levels observed in PD patients, which are correlated with endothelial dysfunction and disease severity, might contribute to microalbuminuria induction. More evidence on this vascular approach comes from white matter lesions (WML), observed in brain imaging, which have been significantly associated with motor and non-motor function in PD patients and are independently associated with microalbuminuria. In this manner, an oxidant and insulin resistant environment, along with low vitamin D levels in PD patients, which are associated with microalbuminuria, might contribute altogether to WML. As the latter are correlated with motor and non-motor function, microalbuminuria might thus give insight on PD status. Prospective cohort studies with an adequate sample size, follow-up, and a thorough battery of clinical tests for PD are needed to confirm this hypothesis.
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Affiliation(s)
- Jesús D Meléndez-Flores
- Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico; Neurology Division, Internal Medicine Department, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Ingrid Estrada-Bellmann
- Neurology Division, Internal Medicine Department, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico; Movement Disorders Clinic, Neurology Division, Internal Medicine Department, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico.
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Chen H, Wan H, Zhang M, Liu G, Wang X, Wang Z, Ma H, Pan Y, Feng T, Wang Y. Cerebral small vessel disease may worsen motor function, cognition, and mood in Parkinson's disease. Parkinsonism Relat Disord 2021; 83:86-92. [PMID: 33493785 DOI: 10.1016/j.parkreldis.2020.12.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 11/07/2020] [Accepted: 12/22/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Emerging evidence has suggested that cerebral small vessel disease (CSVD) may worsen motor function and cognition in Parkinson's disease (PD). However, the effect of CSVD on anxiety and depression in patients with PD remains unknown. This study explored the multi-dimensional effects of CSVD on PD outcomes (motor, cognition, and depression/anxiety). METHODS This cross-sectional study included 431 patients with PD from Beijing Tiantan Hospital from May 2016 to August 2019. CSVD imaging markers were assessed and the four-point CSVD burden score was calculated. Motor function (MDS-UPDRS III score and subscores), cognition (MMSE, MoCA), anxiety (HAMA), and depression (HAMD) were assessed in these patients. The associations of CSVD with these outcomes were analyzed using the Spearman's correlation and multivariable linear regression models. RESULTS Motor dysfunction, cognitive impairment, depression, and anxiety were significantly worse in patients with severe CSVD than in those with mild CSVD. Multivariable linear regression showed that CSVD burden was significantly associated with motor dysfunction (MDS-UPDRS III score and rigidity and bradykinesia subscores), impaired cognition, and high levels of depression and anxiety. A marginally significant association was observed between CSVD burden and gait/postural instability in multivariable regression analysis. Among the CSVD imaging markers, white matter hyperintensity, number of lacunes, and microbleeds were positively correlated with the severity of motor, cognitive, and emotional impairments, while the perivascular space in the basal ganglia was only correlated with cognitive impairments. CONCLUSIONS Comorbid CSVD may affect multiple functional domains in patients with PD. Management of cerebrovascular disease may improve PD outcomes.
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Affiliation(s)
- Huimin Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China; Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China; Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Huijuan Wan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China; Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China; Department of Neurology, First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Meimei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China; Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Genliang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China; Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Xuemei Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China; Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Zhan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China; Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Huizi Ma
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China; Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China; Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Tao Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China; Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China; Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.
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Molnar MJ, Molnar V, Fedor M, Csehi R, Acsai K, Borsos B, Grosz Z. Improving Mood and Cognitive Symptoms in Huntington's Disease With Cariprazine Treatment. Front Psychiatry 2021; 12:825532. [PMID: 35222108 PMCID: PMC8866559 DOI: 10.3389/fpsyt.2021.825532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
In Huntington's disease (HD), the main clinical symptoms include depression, apathy, cognitive deficits, motor deficiencies and involuntary movements. Cognitive, mood and behavioral changes may precede motor symptoms by up to 15 years. The treatment of these diverse symptoms is challenging. Tetrabenazine and deutetrabenazine are the only medications specifically approved for Huntington's chorea, but they do not affect the non-motor symptoms. For these, antidepressants, antipsychotics, and benzodiazepines have demonstrated benefit in some cases and can be used off-label. These drugs, due to sedative side effects, may negatively influence cognition. Sixteen patients having HD received a 12-week off-label cariprazine (CAR) treatment (1.5-3 mg/day). Cognitive performance and behavioral changes were measured by the Addenbrooke Cognitive Examination (ACE) test, the Cognitive and Behavioral part of the Unified Huntington's Disease Rating Scale (UHDRS), and the Beck Depression Inventory (BDI). Mixed model for repeated measures was fitted to the data, with terms of visit, baseline (BL) and their interaction. Cariprazine treatment resulted in the following changes from BL to week 12, respectively: the mean score of BDI decreased from 17.7 ± 10.7 to 10.0 ± 10.7 (p <0.0097), while the Behavioral Assessment score of the UHDRS decreased from 54.9 ± 11.3 to 32.5 ± 15.4 (p < 0.0001); ACE score increased from 75.1 ± 11.0 to 89.0 ± 9.3 (p < 0.0001); Cognitive Verbal Fluency score from 6.2 ± 2.5 to 7.7 ± 2.7 (p < 0.0103); Symbol Digit Test from 9.2 ± 6.9 to 12.3 ± 8.9 (p < 0.0009). Mild akathisia was the most frequent side effect, presenting in 2 out of 16 patients (12.5%). We conclude that CAR had a positive effect on depressive mood, apathy and cognitive functions in patients with early stage of HD. Based on the neurobiological basis of these symptoms, CAR can improve the dopamine imbalance of the prefrontal cortex. This draws attention to the transdiagnostic approach which supports the further understanding of the similar symptomatology of different neuropsychiatric disorders and helps to identify new indications of pharmaceutical compounds.
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Affiliation(s)
- Maria Judit Molnar
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University Budapest, Budapest, Hungary
| | - Viktor Molnar
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University Budapest, Budapest, Hungary
| | - Mariann Fedor
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University Budapest, Budapest, Hungary
| | - Reka Csehi
- Global Medical Division, Richter Gedeon Plc., Budapest, Hungary
| | - Karoly Acsai
- Global Medical Division, Richter Gedeon Plc., Budapest, Hungary
| | - Beata Borsos
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University Budapest, Budapest, Hungary
| | - Zoltan Grosz
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University Budapest, Budapest, Hungary
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Abstract
Early descriptions of subtypes of Parkinson's disease (PD) are dominated by the approach of predetermined groups. Experts defined, from clinical observation, groups based on clinical or demographic features that appeared to divide PD into clinically distinct subsets. Common bases on which to define subtypes have been motor phenotype (tremor dominant vs akinetic-rigid or postural instability gait disorder types), age, nonmotor dominant symptoms, and genetic forms. Recently, data-driven approaches have been used to define PD subtypes, taking an unbiased statistical approach to the identification of PD subgroups. The vast majority of data-driven subtyping has been done based on clinical features. Biomarker-based subtyping is an emerging but still quite undeveloped field. Not all of the subtyping methods have established therapeutic implications. This may not be surprising given that they were born largely from clinical observations of phenotype and not in observations regarding treatment response or biological hypotheses. The next frontier for subtypes research as it applies to personalized medicine in PD is the development of genotype-specific therapies. Therapies for GBA-PD and LRRK2-PD are already under development. This review discusses each of the major subtyping systems/methods in terms of its applicability to therapy in PD, and the opportunities and challenges designing clinical trials to develop the evidence base for personalized medicine based on subtypes.
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Affiliation(s)
- Connie Marras
- Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, Canada.
| | - K Ray Chaudhuri
- Parkinson's Foundation International Centre of Excellence, King's College Hospital and King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Denmark Hill, London, UK
| | - Nataliya Titova
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia
- Department of Neurodegenerative Diseases, Federal Center of Brain and Neurotechnologies, Moscow, Russia
| | - Tiago A Mestre
- The Ottawa Hospital Research Institute and University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada
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Linortner P, McDaniel C, Shahid M, Levine TF, Tian L, Cholerton B, Poston KL. White Matter Hyperintensities Related to Parkinson's Disease Executive Function. Mov Disord Clin Pract 2020; 7:629-638. [PMID: 32775508 PMCID: PMC7396844 DOI: 10.1002/mdc3.12956] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/05/2020] [Accepted: 04/04/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND People with Parkinson's disease (PD) can develop multidomain cognitive impairments; however, it is unclear whether different pathologies underlie domain-specific cognitive dysfunction. OBJECTIVES We investigated the contribution of vascular copathology severity and location, as measured by MRI white matter hyperintensities (WMHs), to domain-specific cognitive impairment in PD. METHODS We studied 85 PD (66.6 ± 9.2 years) and 18 control (65.9 ± 6.6) participants. Using the Fazekas scale for rating the severity of WMH, we subdivided PD into 14 PD-WMH+ and 71 PD-WMH-. Participants underwent global, executive, visuospatial, episodic memory, and language testing. We performed nonparametric permutation testing to create WMH probability maps based on PD-WMH group and cognitive test performance. RESULTS The PD-WMH+ group showed worse global and executive cognitive performance than the PD-WMH- group. On individual tests, the PD-WMH+ group showed worse Montreal Cognitive Assessment (MoCA), Stroop, Symbol Digit Modalities Test (SDMT), and Digit Span scores. WMH probability maps showed that in the PD-WMH+ group, worse Stroop was associated with lesions centered around the corticospinal tract (CST), forceps major, inferior-fronto-occipital fasciculus, and superior longitudinal fasciculus; worse SDMT with lesions around the CST, forceps major, and posterior corona radiata; worse Digit Span with lesions around the posterior corona radiata; and worse MoCA with lesions around the CST. CONCLUSIONS We found that WMH severity was associated with PD executive dysfunction, including worse attention, working memory, and processing speed. Disruption of key white matter tracts in proximity to vascular lesions could contribute to these specific cognitive impairments. Early treatment of vascular disease might mitigate some executive dysfunction in a subset of patients with PD.
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Affiliation(s)
- Patricia Linortner
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
| | - Colin McDaniel
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
| | - Marian Shahid
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
| | - Taylor F. Levine
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
- Psychological & Brain SciencesWashington UniversitySt. LouisMissouriUSA
| | - Lu Tian
- Department of Biomedical Data ScienceStanford UniversityPalo AltoCaliforniaUSA
| | - Brenna Cholerton
- Department of PathologyStanford UniversityPalo AltoCaliforniaUSA
| | - Kathleen L. Poston
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
- Department of NeurosurgeryStanford UniversityPalo AltoCaliforniaUSA
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Dadar M, Gee M, Shuaib A, Duchesne S, Camicioli R. Cognitive and motor correlates of grey and white matter pathology in Parkinson's disease. Neuroimage Clin 2020; 27:102353. [PMID: 32745994 PMCID: PMC7399172 DOI: 10.1016/j.nicl.2020.102353] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/25/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Previous studies have found associations between grey matter atrophy and white matter hyperintensities (WMH) of vascular origin with cognitive and motor deficits in Parkinson's disease (PD). Here we investigate these relationships in a sample of PD patients and age-matched healthy controls. METHODS Data included 50 PD patients and 45 age-matched controls with T1-weighted and FLAIR scans at baseline, 18-months, and 36-months follow-up. Deformation-based morphometry was used to measure grey matter atrophy. SNIPE (Scoring by Nonlocal Image Patch Estimator) was used to measure Alzheimer's disease-like textural patterns in the hippocampi. WMHs were segmented using T1-weighted and FLAIR images. The relationship between MRI features and clinical scores was assessed using mixed-effects models. The motor subscore of the Unified Parkinson's Disease Rating Scale (UPDRSIII), number of steps in a walking trial, and Dementia Rating Scale (DRS) were used respectively as measures of motor function, gait, and cognition. RESULTS Substantia nigra atrophy was significantly associated with motor deficits, with a greater impact in PDs (p < 0.05). Hippocampal SNIPE scores were associated with cognitve decline in both PD and controls (p < 0.01). WMH burden was significantly associated with cognitive decline and increased motor deficits in the PD group, and gait deficits in both PD and controls (p < 0.03). CONCLUSION While substantia nigra atrophy and WMH burden were significantly associated with additional motor deficits, WMH burden and hippocampal atrophy were associated with cognitive deficits in PD patients. These results suggest an additive contribution of both grey and white matter damage to the motor and cognitive deficits in PD.
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Affiliation(s)
- Mahsa Dadar
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Canada.
| | - Myrlene Gee
- Department of Medicine, Division of Neurology, University of Alberta, Canada.
| | - Ashfaq Shuaib
- Department of Medicine, Division of Neurology, University of Alberta, Canada.
| | - Simon Duchesne
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Laval University, Canada.
| | - Richard Camicioli
- Department of Medicine, Division of Neurology, University of Alberta, Canada.
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Hung CH, Hung GU, Wei CY, Tzeng RC, Chiu PY. Function-based dementia severity assessment for vascular cognitive impairment. J Formos Med Assoc 2020; 120:533-541. [PMID: 32653387 DOI: 10.1016/j.jfma.2020.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND/PURPOSES Unimpaired activities of daily living (ADL) is essential for the diagnosis of normal cognition and mild cognitive impairment. However, diagnosis according to this concept is difficult to apply to patients comorbid with motor dysfunction. We aim to use a novel ADL questionnaire for operationally diagnosing unimpaired ADL in vascular cognitive impairment with no dementia (VCIND). METHODS AND PARTICIPANTS This was a retrospective cohort study with both cross-sectional and long-term follow-up analysis. Patients with cerebrovascular disease with normal cognition (CVDNC), VCIND, and vascular dementia (VaD) were analyzed. Cutoff scores for differentiating different stages of cognitive impairment were compared between the new History-based Artificial Intelligent ADL questionnaire (HAI-ADL) and other tools. RESULTS A total of 596 individuals were analyzed, including 40 CVDNC, 167 VCIND, 218 mild, 119 moderate, and 52 severe-dementia patients. The cutoff scores for determining unimpaired ADL in VCIND were 8.5, 3.5, 5, 100, and 60 in HAI-ADL, CDR-SB, IADL, BI, and CASI, respectively. HAI-ADL had the highest correlations with CDR-SB and the CDR staging system compared to other tools. Four models of progression rates from CVDNC/VCIND to VaD revealed it was much higher in the group with HAI-ADL > 8.5 compared to those with HAI-ADL≦8.5 with odds ratios of 3.75, 3.66, 3.31, and 2.77, respectively. CONCLUSION Our study showed that HAI-ADL provides an operational determinates unimpaired ADL which is necessary for the diagnosis of VCIND. The predictive value for progression to dementia was proved by a long-term follow-up analysis of the research cohort.
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Affiliation(s)
- Chao-Hsien Hung
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Ray-Chang Tzeng
- Department of Neurology, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
| | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan; Department of Nursing, College of Nursing and Health Sciences, Da-Yeh University, Dacun, Changhua, Taiwan.
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Effect of small vessel disease burden and lacunes on gait/posture impairment in Parkinson's disease. Neurol Sci 2020; 41:3617-3624. [PMID: 32458249 DOI: 10.1007/s10072-020-04452-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/07/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The comorbidity of cerebral small vessel disease (CSVD) may worsen gait impairment of Parkinson's disease (PD). However, the evidence remains scarce and controversial, and the mechanism of their potential interaction remains largely unknown. The present study aimed to investigate the overall impact of quantity and location of CSVD on gait/posture function in PD. METHODS This cross-sectional study included 315 consecutive eligible patients with PD from Beijing Tiantan Hospital from May 2016 to August 2018. Associations of gait/posture subscores with the burden score of CSVD and four CSVD imaging markers were assessed using multivariate linear regression models. RESULTS Burden of CSVD was significantly associated with more severe gait/posture impairment in PD in the unadjusted model (β = 0.521, P = 0.011, 95% CI 0.118-0.923) and in the model adjusted for age, hypertension, ischemic stroke, low-density lipoprotein level, cholesterol level, and cognitive statues (β = 0.448, P = 0.047, 95% CI 0.006-0.891). The presence of lacunes, but not other CSVD markers, was significantly associated with higher gait/posture subscores after the adjustment (β = 0.492, P = 0.041, 95% CI 0.021-0.964), and the number of lacunes in the basal ganglia significantly correlated with the gait/posture subscores in patients with PD (P = 0.012, Spearman r = 0.161). CONCLUSIONS CSVD and lacunes in the basal ganglia may independently contribute to gait/posture dysfunction in PD. Promoting neurovascular health may preserve some gait/posture function of PD.
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Castillo‐Torres S, Estrada‐Bellmann I, Martínez‐Roque D, Olguín‐Ramírez L, Meléndez‐Flores J, Chávez‐Luévanos B, Góngora‐Rivera F. Readers response to: Does Parkinson's disease increase the risk of cardiovascular events? Eur J Neurol 2019; 27:e11. [DOI: 10.1111/ene.14112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/29/2019] [Indexed: 12/01/2022]
Affiliation(s)
- S.A. Castillo‐Torres
- Servicio de Neurología Hospital Universitario ‘Dr José E. González’ Universidad Autónoma de Nuevo León Monterrey NL México
| | - I. Estrada‐Bellmann
- Servicio de Neurología Hospital Universitario ‘Dr José E. González’ Universidad Autónoma de Nuevo León Monterrey NL México
- Unidad de Cuidados Neurovasculares Hospital Universitario ‘Dr José E. González’ Universidad Autónoma de Nuevo León Monterrey NL México
| | - D.G. Martínez‐Roque
- Servicio de Neurología Hospital Universitario ‘Dr José E. González’ Universidad Autónoma de Nuevo León Monterrey NL México
| | - L.A. Olguín‐Ramírez
- Servicio de Neurología Hospital Universitario ‘Dr José E. González’ Universidad Autónoma de Nuevo León Monterrey NL México
- Clínica de Parkinson y Trastornos del Movimiento Hospital Universitario ‘Dr José E. González’ Universidad Autónoma de Nuevo León Monterrey NL México
| | | | - B. Chávez‐Luévanos
- Servicio de Neurología Hospital Universitario ‘Dr José E. González’ Universidad Autónoma de Nuevo León Monterrey NL México
| | - F. Góngora‐Rivera
- Servicio de Neurología Hospital Universitario ‘Dr José E. González’ Universidad Autónoma de Nuevo León Monterrey NL México
- Clínica de Parkinson y Trastornos del Movimiento Hospital Universitario ‘Dr José E. González’ Universidad Autónoma de Nuevo León Monterrey NL México
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Episodic memory decline in Parkinson' s disease: relation with white matter hyperintense lesions and influence of quantification method. Brain Imaging Behav 2019; 13:810-818. [PMID: 29948903 PMCID: PMC6538581 DOI: 10.1007/s11682-018-9909-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The relation of white matter hyperintense lesions to episodic memory impairment in patients with Parkinson's disease (PD) is still controversial. We aimed at evaluating the relation between white matter hyperintense lesions and episodic memory decline in patients with PD. In this multicentric prospective study, twenty-one normal controls, 15 PD patients without mild cognitive impairment (MCI) and 13 PD patients with MCI were selected to conduct a clinico-radiological correlation analysis. Performance during episodic memory testing, age-related white matter changes score, total manual and automated white matter hyperintense lesions volume and lobar white matter hyperintense lesions volumes were compared between groups using the Kruskal-Wallis and Wilcoxon signed-rank tests, and correlations were assessed using the Spearman test. MCI PD patients had impaired free recall. They also had higher total, left prefrontal and left temporal white matter hyperintense lesions volumes than normal controls. Free recall performance was negatively correlated with the total white matter hyperintense lesions volume, either manually or automatically delineated, but not with the age-related white matter changes score. Using automated segmentation, both the left prefrontal and temporal white matter hyperintense lesions volumes were negatively correlated with the free recall performance. Early episodic memory impairment in MCI PD patients may be related to white matter hyperintense lesions, mainly in the prefrontal and temporal lobes. This relation is influenced by the method used for white matter hyperintense lesions quantification. Automated volumetry allows for detecting those changes.
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Age- and disease-related cerebral white matter changes in patients with Parkinson's disease. Neurobiol Aging 2019; 80:203-209. [DOI: 10.1016/j.neurobiolaging.2019.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 11/18/2022]
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Park YW, Shin N, Chung SJ, Kim J, Lim SM, Lee PH, Lee S, Ahn KJ. Magnetic Resonance Imaging–Visible Perivascular Spaces in Basal Ganglia Predict Cognitive Decline in Parkinson's Disease. Mov Disord 2019; 34:1672-1679. [DOI: 10.1002/mds.27798] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/20/2019] [Accepted: 06/25/2019] [Indexed: 01/17/2023] Open
Affiliation(s)
- Yae Won Park
- Department of Radiology Ewha Womans University College of Medicine Seoul Korea
- Department of Radiology and Research Institute of Radiological Science Yonsei University College of Medicine Seoul Korea
| | - Na‐Young Shin
- Department of Radiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Korea
| | - Seok Jong Chung
- Department of Neurology Yonsei University College of Medicine Seoul Korea
| | - Jiwoong Kim
- Department of Radiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Korea
| | - Soo Mee Lim
- Department of Radiology Ewha Womans University College of Medicine Seoul Korea
| | - Phil Hyu Lee
- Department of Neurology Yonsei University College of Medicine Seoul Korea
| | - Seung‐Koo Lee
- Department of Radiology and Research Institute of Radiological Science Yonsei University College of Medicine Seoul Korea
| | - Kook Jin Ahn
- Department of Radiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Korea
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Shen Y, Dong ZF, Pan PL, Xu G, Huang JY, Liu CF. Association of homocysteine, folate, and white matter hyperintensities in Parkinson's patients with different motor phenotypes. Neurol Sci 2019; 40:1855-1863. [PMID: 31055730 DOI: 10.1007/s10072-019-03906-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/15/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the association of homocysteine (Hcy), folate, and white matter hyperintensities in Parkinson's disease (PD) with different motor phenotypes. METHODS Of the PD patients, 176 were included. Based on the Unified Parkinson's Disease Rating Scale, the PD patients were classified into postural instability gait disorder (PIGD) and non-PIGD phenotypes. According to the Fazekas score, patients were divided into the none/mild white matter hyperintensity (WMH) group and the moderate/severe WMH group. The relationship of Hcy, folate, and white matter hyperintensities (WMHs), and the motor phenotype of PD were analyzed. RESULTS PD-PIGD patients had higher proportion of moderate/severe WMHs, Hcy levels, and lower folate levels than PD-non-PIGD patients (p all ≤ 0.001). In the subgroup analysis, patients with both PD-PIGD and moderate/severe WMHs had the highest Hcy and lowest folate levels compared with others. Binary logistic regression analysis showed that age, folate, and Hcy were independent risk factors for WMHs. In an a priori-determined stratified analysis, after adjustment for confounding factors, the odds ratio of WMHs was 8.01 (95% CI 2.700-23.767, p trend = 0.001) in the patients with Hcy levels in the highest quintile compared with the lowest quintile and 16.81 (95% CI 4.74-59.65, p trend < 0.001) in the patients with folate levels in the lowest quintile compared with the highest quintile. CONCLUSIONS Our data showed a close association between WMHs and Hcy, folate especially in PD-PIGD patients. It can be speculated that higher Hcy and lower folate probably played important roles in the development of WMHs and motor heterogeneity in PD.
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Affiliation(s)
- Yuan Shen
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - Zhi-Feng Dong
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ping-Lei Pan
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - Gang Xu
- Department of Medical Imaging, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - Jun-Ying Huang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China. .,Department of Neurology Institute of Neuroscience, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, China.
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Shibata K, Sugiura M, Nishimura Y, Sakura H. The effect of small vessel disease on motor and cognitive function in Parkinson's disease. Clin Neurol Neurosurg 2019; 182:58-62. [PMID: 31078957 DOI: 10.1016/j.clineuro.2019.04.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 03/03/2019] [Accepted: 04/30/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Small vessel disease (SVD) has been associated with motor and cognitive impairments in neurodegenerative diseases. We investigated SVD markers using brain magnetic resonance imaging (MRI) and the global SVD score in Parkinson's disease (PD). PATIENTS AND METHODS Seventy-one patients with PD were assessed for vascular risk factors, motor severity, and motor phenotype. Global cognition was evaluated using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Based on the MoCA score, we categorized cases into normal (>23) or cognitively impaired (≤23). We calculated the total SVD score (range, 0-4) based on white matter hyper intensities (WMHs), lacunae, cerebral microbleeds (MBs), and enlarged perivascular spaces (PVSs). In addition, we evaluated global brain atrophy. RESULTS There were no significant associations with total SVD score and vascular risk factors, PD severity, and motor phenotype. Increasing age and reduced MMSE and MoCA scores were associated with increased SVD burden. Logistic regression analyses demonstrated that periventricular WMH (PVH), PVS in the basal ganglia (BG-PVS), and atrophy were predictors of cognitive impairment in PD. CONCLUSION The contribution of SVD may be important in elderly patients with PD. Impaired cognition due to SVD-related brain changes was associated with BG-PVS and PVH. These measures suggest that PD with PVS can provide novel insights into SVD.
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Affiliation(s)
- Koichi Shibata
- Department of Medicine, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.
| | - Mieko Sugiura
- Department of Medicine, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.
| | - Yoshiko Nishimura
- Department of Medicine, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.
| | - Hiroshi Sakura
- Department of Medicine, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.
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Mild cognitive impairment in Parkinson's disease. J Neural Transm (Vienna) 2019; 126:897-904. [PMID: 30963293 DOI: 10.1007/s00702-019-02003-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/30/2019] [Indexed: 01/18/2023]
Abstract
Understanding on the clinical features and neural mechanisms leading to cognitive impairment and dementia in Parkinson's disease (PD) has notably increased. At time of diagnosis, nearly all PD patients present some degree of cognitive impairment not enough severe as to significantly affect functional independence. However, even mild cognitive changes have a measurable impact to functional capacity in PD. A clinically practical differentiation is based on the importance of executive deficits in the early phases of cognitive impairment in PD and on the evidence stressing the transitional role of posterior-cortical impairment on the progression of PD-MCI to dementia. However, the pattern of cognitive impairment in PD is variable not just to the extents on which are the affected cognitive domains, but also on which are those domains that became affected first. Specific diagnostic criteria for mild cognitive impairment associated with PD (PD-MCI) and dementia (PDD) and operative guidelines for the cognitive assessment have been developed. In the present review, we will describe general notions regarding the mechanisms and the profile of cognitive deterioration in PD, the diagnostic criteria for PD-MCI, and some of the currently recommended assessment approaches.
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36
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Contribution of white matter lesions to cognitive decline in Parkinson's disease. Parkinsonism Relat Disord 2019; 61:248-249. [DOI: 10.1016/j.parkreldis.2018.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/03/2018] [Accepted: 10/13/2018] [Indexed: 11/21/2022]
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Guzzetti S, Mancini F, Caporali A, Manfredi L, Daini R. The association of cognitive reserve with motor and cognitive functions for different stages of Parkinson's disease. Exp Gerontol 2018; 115:79-87. [PMID: 30502539 DOI: 10.1016/j.exger.2018.11.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/06/2018] [Accepted: 11/23/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The cognitive reserve (CR) theory has been proposed to account for the mismatch between the degree of neuropathological changes and clinical outcome in dementias. Recently, it has also been applied to Parkinson's disease (PD) with promising results, but mostly just focusing on separate proxy measures of CR, such as education, working and leisure time activities, instead of adopting a more comprehensive approach. Using the Cognitive Reserve Index questionnaire (CRIq), this study examined the association of CR with motor functions and cognition in patients with medium-low (1-9 years) and medium-high (>9 years) PD duration. METHODS Fifty patients with PD underwent a neurological and a neuropsychological assessment, comprised of: Unified Parkinson's Disease Rating Scale- section III, Mini-Mental State Examination, Clock-Drawing Test, Rey auditory verbal learning test (immediate and delayed recall trials), Digit Span Forward, Corsi Span Forward, Frontal Assessment Battery, Raven's Colored Progressive Matrices, WAIS similarities subtest, Phonemic Fluency, Semantic Fluency and CRIq. RESULTS PD patients with a higher CRIq score showed a reduced motor impairment and a better global cognitive performance when compared to PD patients with a lower CRIq score, with an advantage especially observed on executive functions and short-term memory. The CR effect was even enhanced in the case of longer disease duration, as observed when considering the overall neuropsychological tests performance and non-verbal abstract reasoning in particular. The results obtained when considering education, as a single proxy measure of CR, provided no additional findings, nor did they reveal all the effects yielded by the adoption of the CRI score. CONCLUSION Our results support the beneficial role of CR against motor and cognitive dysfunctions in PD and suggest that its protective role may be mostly manifested at the later stages of the disease. A theoretical framework able to explain the different impact of CR on Alzheimer Disease and PD is discussed. Finally, our results stressed the importance of using a comprehensive measure of CR instead of focusing on just one of its proxies.
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Affiliation(s)
- Sabrina Guzzetti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy; Parkinson's Disease and Movement Disorders Center, Neurology Service, Humanitas San Pio X, Milan, Italy.
| | - Francesca Mancini
- Parkinson's Disease and Movement Disorders Center, Neurology Service, Humanitas San Pio X, Milan, Italy
| | - Alessandra Caporali
- Parkinson's Disease and Movement Disorders Center, Neurology Service, Humanitas San Pio X, Milan, Italy
| | - Luigi Manfredi
- Parkinson's Disease and Movement Disorders Center, Neurology Service, Humanitas San Pio X, Milan, Italy
| | - Roberta Daini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy; NeuroMI - Milan Center for Neuroscience, Milan, Italy.
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Dadar M, Zeighami Y, Yau Y, Fereshtehnejad SM, Maranzano J, Postuma RB, Dagher A, Collins DL. White matter hyperintensities are linked to future cognitive decline in de novo Parkinson's disease patients. NEUROIMAGE-CLINICAL 2018; 20:892-900. [PMID: 30292088 PMCID: PMC6176552 DOI: 10.1016/j.nicl.2018.09.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/14/2018] [Accepted: 09/25/2018] [Indexed: 11/15/2022]
Abstract
White Matter Hyperintensities (WMHs) are associated with cognitive decline in aging and Alzheimer's disease. However, the pathogenesis of cognitive decline in Parkinson's disease (PD) is not as clearly related to vascular causes, and therefore the role of WMHs as a marker of small-vessel disease (SVD) in PD is less clear. Currently, SVD in PD is assessed and treated independently of the disease. However, if WMH as the major MRI sign of SVD has a higher impact on cognitive decline in PD patients than in healthy controls, vascular pathology needs to be assessed and treated with a higher priority in this population. Here we investigate whether the presence of WMHs leads to increased cognitive decline in de novo PD, and if these effects relate to cortical atrophy. WMHs and cortical thickness were measured in de novo PD patients and age-matched controls (NPD = 365, NControl = 174) from Parkinson's Progression Markers Initiative (PPMI) to study the relationship between baseline WMHs, future cognitive decline (follow-up: 4.09 ± 1.14 years) and cortical atrophy (follow-up: 1.05 ± 0.10 years). PD subjects with high baseline WMH loads had significantly greater cognitive decline than i) PD subjects with low WMH load, and ii) control subjects with high WMH load. Furthermore, in PD subjects, high WMH load resulted in more cortical thinning in the right frontal lobe. Theses results show that the presence of WMHs in de novo PD patients predicts greater future cognitive decline and cortical atrophy than in normal aging.
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Affiliation(s)
- Mahsa Dadar
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; NeuroImaging and Surgical Tools Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
| | - Yashar Zeighami
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
| | - Yvonne Yau
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
| | - Seyed-Mohammad Fereshtehnejad
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Division of Neurology, Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Josefina Maranzano
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
| | - Ronald B Postuma
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
| | - Alain Dagher
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
| | - D Louis Collins
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; NeuroImaging and Surgical Tools Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
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Caviness JN, Beach TG, Hentz JG, Shill HA, Driver-Dunckley ED, Adler CH. Association Between Pathology and Electroencephalographic Activity in Parkinson's Disease. Clin EEG Neurosci 2018; 49:321-327. [PMID: 29161906 DOI: 10.1177/1550059417696179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The key mechanisms that connect Parkinson's disease pathology with dementia are unclear. We tested the hypothesis that the quantitative spectral electroencephalographic measure, delta bandpower, correlates with Lewy type synucleinopathy on pathological examination in Parkinson's disease. As a corollary hypothesis, we analyzed whether there would be delta bandpower electroencephalographic differences between Parkinson's disease dementia cases with and without pathological criteria for Alzheimer's disease. METHODS We used pathological examination results from 44 Parkinson's disease subjects from our brain bank with various degrees of cognitive decline, who had undergone electroencephalography. Pathological grading for Lewy type synucleinopathy, plaques, tangles, and indications of vascular pathology in subcortical and cortical areas were correlated with the most associated electroencephalographic biomarker with Parkinson's disease dementia in our laboratory, delta bandpower. Group differences for all spectral electroencephalographic measures were also analyzed between cases with and without pathological criteria for Alzheimer's disease. RESULTS Findings revealed significant correlations between delta bandpower with Lewy type synucleinopathy, whereas indications of Alzheimer's disease or vascular pathology had nonsignificant correlation. The strongest association was with delta bandpower and Lewy type synucleinopathy in the anterior cingulate region. Mean delta bandpower was higher in the group for Parkinson's disease dementia with Alzheimer's disease pathology criteria than without. CONCLUSIONS Lewy type synucleinopathy severity appears to be more associated with increased delta bandpower than with Alzheimer's disease pathology or indications of vascular pathology over all cases. However, the presence of Alzheimer's pathology may associate with more cortex physiological disruption in a subset of cases.
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Affiliation(s)
| | - Thomas G Beach
- 2 Civin Laboratory for Neuropathology, Banner-Sun Health Research Institute, Sun City, AZ, USA
| | - Joseph G Hentz
- 3 Department of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Holly A Shill
- 4 Barrow Neurological Institute, St Joseph's Hospital, Phoenix, AZ, USA
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Weinkle LJ, Hoyt B, Thompson JA, Sillau S, Tanabe J, Honce J, Klepitskaya O. Association of MRI Measurements with Cognitive Outcomes After STN-DBS in Parkinson's Disease. Mov Disord Clin Pract 2018; 5:417-426. [PMID: 30363383 DOI: 10.1002/mdc3.12643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/16/2018] [Accepted: 05/14/2018] [Indexed: 01/29/2023] Open
Abstract
Objectives Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for improving the motor symptoms of Parkinson's disease (PD). Overall, cognitive function remains stable after STN-DBS in most patients. However, cognitive decline, specifically in the verbal fluency domain, is seen in a subset of STN-DBS patients. Currently, predictors of cognitive decline in PD patients treated with STN-DBS are not well known. Thus, identification of presurgical predictors might provide an important clinical tool for better risk-to-benefit assessment. This study explores whether whole brain white matter lesion (WML) volume, or hippocampal and forebrain volumes, measured quantitatively on MRI, are associated with cognitive changes following STN-DBS in PD patients. Methods We conducted a retrospective study using presurgical, and ≥ 6-month postsurgical neuropsychological (NP) evaluation scores from 43 PD patients with STN-DBS. Mean pre/post NP test scores for measures of executive function, attention, verbal fluency, memory, and visuospatial function were analyzed and correlated with WML volume, and brain volumetric data. Results Although cognitive measures of verbal fluency, executive function, attention, memory, and visuospatial function showed declines following STN-DBS, we observed limited evidence that white matter lesion burden or cortical atrophy contributed to cognitive change following STN-DBS. Conclusions These results suggest that post-STN-DBS cognitive changes may be unrelated to presurgical WML burden and presence of cortical atrophy.
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Affiliation(s)
- Laura J Weinkle
- Department of Neurology University of Colorado School of Medicine Aurora Colorado USA.,Modern Human Anatomy Program University of Colorado School of Medicine Aurora Colorado USA
| | - Brian Hoyt
- Department of Neurosurgery University of Colorado School of Medicine Aurora Colorado USA
| | - John A Thompson
- Department of Neurosurgery University of Colorado School of Medicine Aurora Colorado USA.,Modern Human Anatomy Program University of Colorado School of Medicine Aurora Colorado USA
| | - Stefan Sillau
- Department of Neurology University of Colorado School of Medicine Aurora Colorado USA
| | - Jody Tanabe
- Department of Neuroradiology University of Colorado School of Medicine Aurora Colorado USA
| | - Justin Honce
- Department of Neuroradiology University of Colorado School of Medicine Aurora Colorado USA
| | - Olga Klepitskaya
- Department of Neurology University of Colorado School of Medicine Aurora Colorado USA
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41
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Goldman JG, Vernaleo BA, Camicioli R, Dahodwala N, Dobkin RD, Ellis T, Galvin JE, Marras C, Edwards J, Fields J, Golden R, Karlawish J, Levin B, Shulman L, Smith G, Tangney C, Thomas CA, Tröster AI, Uc EY, Coyan N, Ellman C, Ellman M, Hoffman C, Hoffman S, Simmonds D. Cognitive impairment in Parkinson's disease: a report from a multidisciplinary symposium on unmet needs and future directions to maintain cognitive health. NPJ Parkinsons Dis 2018; 4:19. [PMID: 29951580 PMCID: PMC6018742 DOI: 10.1038/s41531-018-0055-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 04/29/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023] Open
Abstract
People with Parkinson's disease (PD) and their care partners frequently report cognitive decline as one of their greatest concerns. Mild cognitive impairment affects approximately 20-50% of people with PD, and longitudinal studies reveal dementia in up to 80% of PD. Through the Parkinson's Disease Foundation Community Choice Research Award Program, the PD community identified maintaining cognitive function as one of their major unmet needs. In response, a working group of experts across multiple disciplines was organized to evaluate the unmet needs, current challenges, and future opportunities related to cognitive impairment in PD. Specific conference goals included defining the current state in the field and gaps regarding cognitive issues in PD from patient, care partner, and healthcare professional viewpoints; discussing non-pharmacological interventions to help maintain cognitive function; forming recommendations for what people with PD can do at all disease stages to maintain cognitive health; and proposing ideas for how healthcare professionals can approach cognitive changes in PD. This paper summarizes the discussions of the conference, first by addressing what is currently known about cognitive dysfunction in PD and discussing several non-pharmacological interventions that are often suggested to people with PD. Second, based on the conference discussions, we provide considerations for people with PD for maintaining cognitive health and for healthcare professionals and care partners when working with people with PD experiencing cognitive impairment. Furthermore, we highlight key issues and knowledge gaps that need to be addressed in order to advance research in cognition in PD and improve clinical care.
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Affiliation(s)
- Jennifer G. Goldman
- Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago, IL USA
| | | | | | - Nabila Dahodwala
- Department of Neurology, University of Pennsylvania, Philadelphia, PA USA
| | - Roseanne D. Dobkin
- Department of Psychiatry, Rutgers The State University of New Jersey, New Brunswick, NJ USA
| | - Terry Ellis
- Department of Physical Therapy and Athletic Training and Center for Neurorehabilitation, Boston University, Boston, MA USA
| | - James E. Galvin
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL USA
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson’s disease, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON Canada
| | | | - Julie Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
| | - Robyn Golden
- Department of Health and Aging, Rush University Medical Center, Chicago, IL USA
| | - Jason Karlawish
- Department of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Bonnie Levin
- Department of Neurology, Division of Neuropsychology, University of Miami, Miami, FL USA
| | - Lisa Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD USA
| | - Glenn Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL USA
| | - Christine Tangney
- Department of Clinical Nutrition, College of Health Sciences, Rush University Medical Center, Chicago, IL USA
| | - Cathi A. Thomas
- Department of Neurology, Boston University Medical Campus, Boston, MA USA
| | - Alexander I. Tröster
- Department of Clinical Neuropsychology and Center for Neuromodulation, Barrow Neurological Institute, Phoenix, AZ USA
| | - Ergun Y. Uc
- Department of Neurology, University of Iowa, and Neurology Service, Iowa City, Veterans Affairs Health Care Systen, Iowa City, IA USA
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Lee JY, Kim J, Jang W, Park J, Oh E, Youn J, Park S, Cho J. Association between White Matter Lesions and Non-Motor Symptoms in Parkinson Disease. NEURODEGENER DIS 2018; 18:127-132. [DOI: 10.1159/000489311] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/17/2018] [Indexed: 11/19/2022] Open
Abstract
Background: There are only few studies exploring the relationship between white matter lesions (WMLs) and non-motor symptoms in Parkinson disease (PD). This study aimed to investigate the association between WMLs and the severity of non-motor symptoms in PD. Methods: The severity of motor dysfunction, cognitive impairment, and non-motor symptoms was assessed by various scales in 105 PD patients. We used a visual semiquantitative rating scale and divided the subjects into four groups: no, mild, moderate, and severe WMLs. We compared the means of all scores between the four groups and analyzed the association between the severity of WMLs and the specific domain of non-motor symptoms. Results: The non-motor symptoms as assessed by the Non-Motor Symptoms Scale, Parkinson’s Disease Questionnaire (PDQ-39), Parkinson’s Disease Sleep Scale, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Neuropsychiatric Inventory (NPI), and Parkinson Fatigue Scale (PFS) were significantly worse in the patients with moderate and severe WMLs than in those without WMLs. Compared with the no WML group, the scores for motor dysfunction were significantly higher in the mild, moderate, and severe WML groups. The scores for cognitive dysfunction were significantly higher in the patients with severe WMLs than in those without WMLs. The severity of WMLs showed linear associations with PFS, BDI, BAI, NPI, and PDQ-39 scores. The severity of WMLs also correlated linearly with scores for motor and cognitive dysfunction. Conclusions: Among the non-motor symptoms, fatigue, depression, anxiety, and quality of life were significantly affected by WMLs in PD. Confirmation of the possible role of WMLs in non-motor symptoms associated with PD in a prospective manner may be crucial not only for understanding non-motor symptoms but also for the development of treatment strategies.
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43
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The Effect of Associated Parkinsonism on Rehabilitation in Stroke Patients: A Case Series. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:64-69. [PMID: 32595376 PMCID: PMC7315070 DOI: 10.14744/semb.2017.69772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/20/2017] [Indexed: 11/20/2022]
Abstract
Stroke and Parkinson’s disease are 2 major causes of movement impairment and a decreased ability to perform daily activities. The aim of this case series was to demonstrate the difficulty of rehabilitation in stroke patients with accompanying parkinsonism. Four stroke patients with parkinsonism who underwent rehabilitation at the Physical Medicine and Rehabilitation Clinic between March and May of 2016 were evaluated. The Standardized Mini-Mental State Examination (SMMSE), the Functional Independence Measure (FIM), the Barthel Index (BI), the Berg Balance Scale (BBS), and the Stroke Impact Scale version 3.0 (SIS) were used in the assessment. Of the 4 patients, 3 were female, and the mean age was 74.5±9.3 years. The mean hospital stay was 19±5.3 days. The initial test scores recorded were low, and they remained low at the time of discharge. After rehabilitation, the mean FIM score in the group was 42% of the maximum possible score, the mean SMMSE was 55%, the BI was 18%, the BBS was 0.08%, and the SIS was 25%. Three patients required a wheelchair, and 1 patient could ambulate with a walker at discharge. A stroke accompanied by parkinsonism negatively affects mobility and functional status, primarily through the deterioration of balance. In this study, cognitive function was reduced to half of the maximum, and the balance and function loss was more than 50%. Barthel index; berg balance scale; functional independence measure; mini-mental state examination; parkinsonism; stroke; stroke impact scale.
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44
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Stojkovic T, Stefanova E, Soldatovic I, Markovic V, Stankovic I, Petrovic I, Agosta F, Galantucci S, Filippi M, Kostic V. Exploring the relationship between motor impairment, vascular burden and cognition in Parkinson's disease. J Neurol 2018; 265:1320-1327. [PMID: 29572571 DOI: 10.1007/s00415-018-8838-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine frequency and type of cognitive disorders in cross-sectional analysis of a Parkinson's disease (PD) cohort, and explore its relations to motor symptoms, modifiable vascular risk factors and white matter lesions (WML) volume. METHODS In a group of 133 PD patients, mild cognitive impairment (PD-MCI) and dementia (PDD) were diagnosed according to Movement Disorders Society Task Force criteria (level 2 for PD-MCI). Detailed motor measurements were applied, including rigidity, axial, bradykinesia, tremor and postural instability gait disorders (PIGD) scores. Vascular risk was estimated by the Framingham General Cardiovascular Disease risk scoring algorithm and WML volume was measured for whole brain and frontal lobe. RESULTS Sixty-one (46.9%) patients fulfilled criteria for PD-MCI, and 23 (17.7%) for PDD. Non-amnestic multiple domain MCI was most frequent (52% of PD-MCI patients). Motor scores were significantly higher in cognitively impaired patients, but only axial score discriminated between MCI and dementia. High vascular risk was related to impaired cognition, bradykinesia, axial, PIGD and freezing of gait (FOG) score, while whole brain WML volume was associated with PDD, FOG and attention deficits. Furthermore, high vascular risk was identified as a potential predictor of both MCI and dementia in PD. Additionally, age and bradykinesia score were independently associated with PD-MCI and age, axial score and whole brain WML volume with PDD. CONCLUSION Cognitive disorders in PD are associated with more severe, predominantly axial motor deficits and increased, but partly modifiable vascular burden, thus opening a possibility for development of preventive strategies in PD.
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Affiliation(s)
- Tanja Stojkovic
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
- School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Elka Stefanova
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Soldatovic
- Institute of Medical Statistics, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladana Markovic
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Iva Stankovic
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Igor Petrovic
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Sebastiano Galantucci
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Vladimir Kostic
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
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45
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Del-Monte J, Bayard S, Graziani P, Gély-Nargeot MC. Cognitive, Emotional, and Auto-Activation Dimensions of Apathy in Parkinson's Disease. Front Behav Neurosci 2017; 11:230. [PMID: 29209182 PMCID: PMC5702439 DOI: 10.3389/fnbeh.2017.00230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 11/07/2017] [Indexed: 02/02/2023] Open
Abstract
Apathy is one of the most frequent non-motor manifestations in Parkinson's disease (PD) that can lead to a whole range of deleterious outcomes. In 2006, Levy and Dubois proposed a model that distinguishes three different apathy aetiologies in PD divided into three subtypes of disrupted processing: “emotional-affective,” “cognitive,” and “auto-activation.” These three dimensions associated with dopamine depletion present in the pathology would lead to the emergence of apathy in PD. The aim of this mini-review was to describe and discuss studies that have explore links between apathy and the three subtypes of disrupted processing proposed by Levy and Dubois (2006) and as well as the links between these dimensions and dopamine depletion in Parkinson's disease. The lack of consensus regarding the emotional-affective correlates of apathy and the lack of evidence supporting the hypothesis of the auto-activation deficit, do not clearly confirm the validity of Levy and Dubois's model. Furthermore, the suggested association between dopaminergic depletion and apathy must also be clarified.
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Affiliation(s)
- Jonathan Del-Monte
- Social Psychology Laboratory EA 849, Aix-Marseille and Nîmes Universities, Nîmes, France
| | - Sophie Bayard
- Epsylon, Laboratory Dynamic of Human Abilities & Health Behaviors, Department of Sport Sciences, Psychology and Medicine, Montpellier University, Montpellier, France
| | - Pierluigi Graziani
- Social Psychology Laboratory EA 849, Aix-Marseille and Nîmes Universities, Nîmes, France
| | - Marie C Gély-Nargeot
- Epsylon, Laboratory Dynamic of Human Abilities & Health Behaviors, Department of Sport Sciences, Psychology and Medicine, Montpellier University, Montpellier, France
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46
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Sartor J, Bettecken K, Bernhard FP, Hofmann M, Gladow T, Lindig T, Ciliz M, Ten Kate M, Geritz J, Heinzel S, Benedictus M, Scheltens P, Hobert MA, Maetzler W. White Matter Changes-Related Gait and Executive Function Deficits: Associations with Age and Parkinson's Disease. Front Aging Neurosci 2017; 9:213. [PMID: 28713264 PMCID: PMC5491602 DOI: 10.3389/fnagi.2017.00213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/16/2017] [Indexed: 01/22/2023] Open
Abstract
Background: White matter changes (WMC) are a common finding among older adults and patients with Parkinson's disease (PD), and have been associated with, e.g., gait deficits and executive dysfunction. How the factors age and PD influence WMC-related deficits is, to our best knowledge, not investigated to date. We hypothesized that advanced age and presence of PD leads to WMC-related symptoms while practicing tasks with a low complexity level, and low age and absence of PD leads to WMC-related symptoms while practicing tasks with a high complexity level. Methods: Hundred and thirty-eight participants [65 young persons without PD (50–69 years, yPn), 22 young PD patients (50–69 years, yPD), 36 old persons without PD (70–89 years, oPn) and 15 old PD patients (70–89 years, oPD)] were included. Presence and severity of WMC were determined with the modified Fazekas score. Velocity of walking under single and dual tasking conditions and the Trail Making Test (TMT) were used as gait and executive function parameters. Correlations between presence and severity of WMC, and gait and executive function parameters were tested in yPn, yPD, oPn, and oPD using Spearman's rank correlation, and significance between groups was evaluated with Fisher's z-transformed correlation coefficient. Results: yPn and yPD, as well as oPn and oPD did not differ regarding demographic and clinical parameters. Severity of WMC was not significantly different between groups. yPn and yPD displayed significant correlations of WMC with executive function parameters at low levels of task complexity, oPn at intermediate, and oPD at high complexity levels. Conclusion: This study argues for a relevant association of age and PD-related brain pathology with WMC-related gait and executive function deficits.
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Affiliation(s)
- Jennifer Sartor
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | - Kristina Bettecken
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | - Felix P Bernhard
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | | | | | - Tobias Lindig
- Department of Diagnostic and Interventional Neuroradiology, University of TuebingenTuebingen, Germany
| | - Meltem Ciliz
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany
| | - Mara Ten Kate
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical CenterAmsterdam, Netherlands
| | - Johanna Geritz
- Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
| | - Marije Benedictus
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical CenterAmsterdam, Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical CenterAmsterdam, Netherlands
| | - Markus A Hobert
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
| | - Walter Maetzler
- Department of Neurodegeneration, Center for Neurology and Hertie Institute for Clinical Brain Research, University of TuebingenTuebingen, Germany.,German Center for Neurodegenerative Diseases (DZNE)Tuebingen, Germany.,Department of Neurology, Christian-Albrechts-University of KielKiel, Germany
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47
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Blume J, Lange M, Rothenfusser E, Doenitz C, Bogdahn U, Brawanski A, Schlaier J. The impact of white matter lesions on the cognitive outcome of subthalamic nucleus deep brain stimulation in Parkinson's disease. Clin Neurol Neurosurg 2017; 159:87-92. [PMID: 28582689 DOI: 10.1016/j.clineuro.2017.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/24/2017] [Accepted: 05/27/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES White Matter lesions (WML) are a risk factor for cognitive impairment in Parkinson's disease. There is no clear evidence of reduced general cognitive function after DBS. However, a subgroup of patients develops dementia rapidly after DBS despite careful patient selection processes. The aim of this study was to evaluate the load of WML as a possible risk factor for cognitive decline following STN DBS. PATIENTS AND METHODS 40 PD-patients receiving bilateral STN-DBS were followed at least three years after surgery to detect dementia. All patients underwent comprehensive neuropsychological assessment and MRI before surgery. The extent of WML was assessed using an automated approach. WML volume was correlated to the onset of dementia and the decline of a cognitive composite score retrospectively. RESULTS Patients with a rapid onset of dementia within one, respective three following DBS showed significant higher WML volumes compared to cognitive normal and MCI patients (55.8cm3±18.836 vs. 9.3cm3±12.2; p=0.002). The same significant association was found in a multivariable model, including the covariables age, gender and PD disease duration (p=0.01). WML volume was associated to the rate of decline in cognitive composite score within three years after DBS surgery (p=0.006; R2=0.40) after correction for age. CONCLUSIONS Damaged white matter may lead to a reduced compensation of disconnections in cognitive circuits caused by the implantation of the DBS electrodes or by chronic stimulation. The role of WML as a prognostic factor for the cognitive outcome after DBS may be underestimated. The WML burden should be taken seriously in preoperative risk stratification.
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Affiliation(s)
- J Blume
- Department of Neurology, University of Regensburg, Medical Center, Germany; Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany.
| | - M Lange
- Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany; Department of Neurosurgery, University of Regensburg, Medical Center, Germany
| | - E Rothenfusser
- Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany
| | - C Doenitz
- Department of Neurosurgery, University of Regensburg, Medical Center, Germany
| | - U Bogdahn
- Department of Neurology, University of Regensburg, Medical Center, Germany
| | - A Brawanski
- Department of Neurosurgery, University of Regensburg, Medical Center, Germany
| | - J Schlaier
- Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany; Department of Neurosurgery, University of Regensburg, Medical Center, Germany
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48
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Pilotto A, Turrone R, Liepelt-Scarfone I, Bianchi M, Poli L, Borroni B, Alberici A, Premi E, Formenti A, Bigni B, Cosseddu M, Cottini E, Berg D, Padovani A. Vascular Risk Factors and Cognition in Parkinson's Disease. J Alzheimers Dis 2016; 51:563-70. [PMID: 26890741 DOI: 10.3233/jad-150610] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Vascular risk factors have been associated with cognitive deficits and incident dementia in the general population, but their role on cognitive dysfunction in Parkinson's disease (PD) is still unclear. The present study addresses the single and cumulative effect of vascular risk factors on cognition in PD patients, taking clinical confounders into account. Standardized neuropsychological assessment was performed in 238 consecutive PD patients. We evaluated the association of single and cumulative vascular risk factors (smoking, diabetes, hypercholesterolemia, hypertension, and heart disease), with the diagnosis of PD normal cognition (PDNC, n = 94), mild cognitive impairment (PD-MCI, n = 111), and dementia (PDD, n = 33). The association between single neuropsychological tests and vascular risk factors was evaluated with covariance analyses adjusted for age at onset, educational levels, gender, disease duration, and motor performance. Age, educational levels, disease duration, and motor function were significantly different between PDNC, PD-MCI, and PDD. Heart disease was the only vascular factor significantly more prevalent in PDD compared with PDNC in adjusted analyses. Performance of tests assessing executive and attention functions were significantly worse in patients with hypertension, heart disease, and/or diabetes (p < 0.05). Heart disease is associated with dementia in PD, suggesting a potential window of intervention. Vascular risk factors act especially on attention and executive functions in PD. Vascular risk stratification may be useful in order to identify PD patients with a greater risk of developing dementia. These findings need to be verified in longitudinal studies.
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Affiliation(s)
- Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy.,Department of Neurodegeneration, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Rosanna Turrone
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases, Tübingen, Germany
| | - Marta Bianchi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Loris Poli
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Antonella Alberici
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Enrico Premi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy.,Neurovascular Unit, Brescia Hospital, Italy
| | - Anna Formenti
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Barbara Bigni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Maura Cosseddu
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Elisabetta Cottini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases, Tübingen, Germany
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
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49
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Caproni S, Colosimo C. Movement disorders and cerebrovascular diseases: from pathophysiology to treatment. Expert Rev Neurother 2016; 17:509-519. [DOI: 10.1080/14737175.2017.1267566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stefano Caproni
- Dipartimento di Neuroscienze, Azienda Ospedaliero-Universitaria Santa Maria, Terni, Italy
| | - Carlo Colosimo
- Dipartimento di Neuroscienze, Azienda Ospedaliero-Universitaria Santa Maria, Terni, Italy
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50
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Vetrano DL, Pisciotta MS, Brandi V, Lo Monaco MR, Laudisio A, Onder G, Fusco D, L′Angiocola PD, Bentivoglio AR, Bernabei R, Zuccalà G. Impact of disease duration and cardiovascular dysautonomia on hypertension in Parkinson's disease. J Clin Hypertens (Greenwich) 2016; 19:418-423. [DOI: 10.1111/jch.12938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Davide L. Vetrano
- Aging Research Center; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet and Stockholm University; Stockholm Sweden
- Department of Geriatrics, Neurosciences and Orthopaedics; Catholic University of Rome; Rome Italy
| | - Maria S. Pisciotta
- Department of Geriatrics, Neurosciences and Orthopaedics; Catholic University of Rome; Rome Italy
| | - Vincenzo Brandi
- Department of Geriatrics, Neurosciences and Orthopaedics; Catholic University of Rome; Rome Italy
| | - Maria R. Lo Monaco
- Department of Geriatrics, Neurosciences and Orthopaedics; Catholic University of Rome; Rome Italy
| | - Alice Laudisio
- Department of Geriatrics; Campus Bio-Medico University; Rome Italy
| | - Graziano Onder
- Department of Geriatrics, Neurosciences and Orthopaedics; Catholic University of Rome; Rome Italy
| | - Domenico Fusco
- Department of Geriatrics, Neurosciences and Orthopaedics; Catholic University of Rome; Rome Italy
| | | | - Anna R. Bentivoglio
- Institute of Neurology; Catholic University of Rome; Rome Italy
- “Don Gnocchi” Foundation; Milan Italy
| | - Roberto Bernabei
- Department of Geriatrics, Neurosciences and Orthopaedics; Catholic University of Rome; Rome Italy
| | - Giuseppe Zuccalà
- Department of Geriatrics, Neurosciences and Orthopaedics; Catholic University of Rome; Rome Italy
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