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Sala A, Caminiti SP, Iaccarino L, Beretta L, Iannaccone S, Magnani G, Padovani A, Ferini-Strambi L, Perani D. Vulnerability of multiple large-scale brain networks in dementia with Lewy bodies. Hum Brain Mapp 2019; 40:4537-4550. [PMID: 31322307 DOI: 10.1002/hbm.24719] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/01/2019] [Accepted: 06/19/2019] [Indexed: 01/08/2023] Open
Abstract
Aberrations of large-scale brain networks are found in the majority of neurodegenerative disorders. The brain connectivity alterations underlying dementia with Lewy bodies (DLB) remain, however, still elusive, with contrasting results possibly due to the pathological and clinical heterogeneity characterizing this disorder. Here, we provide a molecular assessment of brain network alterations, based on cerebral metabolic measurements as proxies of synaptic activity and density, in a large cohort of DLB patients (N = 72). We applied a seed-based interregional correlation analysis approach (p < .01, false discovery rate corrected) to evaluate large-scale resting-state networks' integrity and their interactions. We found both local and long-distance metabolic connectivity alterations, affecting the posterior cortical networks, that is, primary visual and the posterior default mode network, as well as the limbic and attention networks, suggesting a widespread derangement of the brain connectome. Notably, patients with the lowest visual and attention cognitive scores showed the most severe connectivity derangement in regions of the primary visual network. In addition, network-level alterations were differentially associated with the core clinical manifestations, namely, hallucinations with more severe metabolic dysfunction of the attention and visual networks, and rapid eye movement sleep behavior disorder with alterations of connectivity of attention and subcortical networks. These multiple network-level vulnerabilities may modulate the core clinical and cognitive features of DLB and suggest that DLB should be considered as a complex multinetwork disorder.
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Affiliation(s)
- Arianna Sala
- Vita-Salute San Raffaele University, Milan, Italy.,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Paola Caminiti
- Vita-Salute San Raffaele University, Milan, Italy.,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Iaccarino
- Vita-Salute San Raffaele University, Milan, Italy.,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Beretta
- In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sandro Iannaccone
- Clinical Neuroscience Department, San Raffaele Turro Hospital, Milan, Italy
| | - Giuseppe Magnani
- Department of Neurology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Ferini-Strambi
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, San Raffaele Scientific Institute, Neurology, Sleep Disorders Center, Milan, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy.,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
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Supasitthumrong T, Herrmann N, Tunvirachaisakul C, Shulman K. Clock drawing and neuroanatomical correlates: A systematic review. Int J Geriatr Psychiatry 2019; 34:223-232. [PMID: 30370637 DOI: 10.1002/gps.5013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/05/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The popular clock drawing test (CDT) is easy to administer, acceptable to patients, and has excellent psychometric properties. Although it has been used primarily as a cognitive screening test, many studies have attempted to establish the CDT's ability to localize specific brain lesions or pathology. This systematic review aimed to summarize the evidence on the neuroanatomical correlates of the CDT. METHODS Using PRISMA guidelines, the authors systematically reviewed the evidence on neuroanatomical correlates of clock drawing by a systematic search in six databases (Pubmed, CINHL, PsychINFO, HealthStar, Embase, and Web of Science) until January 2018. Studies were included if they reported CDT correlations with anatomical brain lesions documented by neuroimaging. RESULTS Forty-five papers met inclusion criteria. Thirty-one studies identified distinct areas of neuroanatomical correlates of CDT utilizing different scoring methods and imaging techniques. Nine articles reported on the degree of white matter hyperintensities that correlated with lower scores on CDT and the severity of cognitive deficits. Five articles focused on postacute cerebrovascular accidents correlated with CDT performance. A variety of different anatomical lesions, located in all areas of the brain, were associated with abnormalities on the CDT. CONCLUSIONS The CDT, regardless of scoring method and population studied, was not associated with any consistent, specific brain localization. This systematic review supports the use of the CDT as a cognitive screening test rather than a method of localizing brain lesions.
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Affiliation(s)
- Thitiporn Supasitthumrong
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nathan Herrmann
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Kenneth Shulman
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Alexopoulos P, Gleixner LS, Werle L, Buhl F, Thierjung N, Giourou E, Kagerbauer SM, Gourzis P, Kübler H, Grimmer T, Yakushev I, Martin J, Kurz A, Perneczky R. Plasma levels of soluble amyloid precursor protein β in symptomatic Alzheimer's disease. Eur Arch Psychiatry Clin Neurosci 2018; 268:519-524. [PMID: 28602012 DOI: 10.1007/s00406-017-0815-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 06/06/2017] [Indexed: 11/29/2022]
Abstract
The established biomarkers of Alzheimer's disease (AD) require invasive endeavours or presuppose sophisticated technical equipment. Consequently, new biomarkers are needed. Here, we report that plasma levels of soluble amyloid precursor protein β (sAPPβ), a protein of the initial phase of the amyloid cascade, were significantly lower in patients with symptomatic AD (21 with mild cognitive impairment due to AD and 44 with AD dementia) with AD-typical cerebral hypometabolic pattern compared with 27 cognitively healthy elderly individuals without preclinical AD. These findings yield further evidence for the potential of sAPPβ in plasma as an AD biomarker candidate.
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Affiliation(s)
- Panagiotis Alexopoulos
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany. .,Department of Psychiatry, University Hospital of Rion, University of Patras, 26500, Patras, Greece.
| | - Lena-Sophie Gleixner
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lukas Werle
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Max Planck Institute of Psychiatry, Munich, Germany
| | - Felix Buhl
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nathalie Thierjung
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Evangelia Giourou
- Department of Psychiatry, University Hospital of Rion, University of Patras, 26500, Patras, Greece
| | - Simone M Kagerbauer
- Department of Anaesthesiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philippos Gourzis
- Department of Psychiatry, University Hospital of Rion, University of Patras, 26500, Patras, Greece
| | - Hubert Kübler
- Department of Urology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Igor Yakushev
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan Martin
- Department of Anaesthesiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Kurz
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Robert Perneczky
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany.,Neuroepidemiology and Ageing Research Unit, Faculty of Medicine, School of Public Health, The Imperial College of Science, Technology and Medicine, London, UK.,West London Mental Health NHS Trust, London, UK.,German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany
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Trojano L, Gainotti G. Drawing Disorders in Alzheimer's Disease and Other Forms of Dementia. J Alzheimers Dis 2017; 53:31-52. [PMID: 27104898 DOI: 10.3233/jad-160009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drawing is a multicomponential process that can be impaired by many kinds of brain lesions. Drawing disorders are very common in Alzheimer's disease and other forms of dementia, and can provide clinical information for the distinction of the different dementing diseases. In our review we started from an overview of the neural and cognitive bases of drawing, and from a recollection of the drawing tasks more frequently used for assessing individuals with dementia. Then, we analyzed drawing disorders in dementia, paying special attention to those observed in Alzheimer's disease, from the prodromal stages of the amnesic mild cognitive impairment to the stages of full-blown dementia, both in the sporadic forms with late onset in the entorhino-hippocampal structures and in those with early onset in the posterior neocortical structures. We reviewed the drawing features that could differentiate Alzheimer's disease from vascular dementia and from the most frequent forms of degenerative dementia, namely frontotemporal dementia and Lewy body disease. Finally, we examined some peculiar aspects of drawing disorders in dementia, such as perseverations, rotations, and closing-in. We argue that a careful analysis of drawing errors helps to differentiate the different forms of dementia more than overall accuracy in drawing.
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Affiliation(s)
- Luigi Trojano
- Department of Psychology, Second University of Naples, Italy.,S. Maugeri Foundation, Scientific Institute of Telese Terme (BN), Italy
| | - Guido Gainotti
- Center for Neuropsychological Research, Institute of Neurology, Catholic University, Rome, Italy.,IRCCS Fondazione Santa Lucia, Department of Clinical and Behavioral Neurology, Rome, Italy
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Riedel O, Klotsche J, Förstl H, Wittchen HU. Clock drawing test: is it useful for dementia screening in patients having Parkinson disease with and without depression? J Geriatr Psychiatry Neurol 2013; 26:151-7. [PMID: 23720572 DOI: 10.1177/0891988713490994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Despite the wide use of clock drawing tests (CDTs) for screening cognitive impairment, their use in patients having Parkinson disease (PD) with dementia has not been systematically investigated until date. In this cross-sectional study, neurological and neuropsychiatric statuses of 1449 outpatients having PD with and without dementia were comprehensively assessed. The CDT revealed cognitive impairment in 42.7% of the 1383 patients whose drawings were available. Overall, CDT sensitivity and specificity were 70.7% and 68.9%, respectively. The positive and negative predictive values were 48.0% and 85.3%, respectively. In patients with depression, CDT specificity dropped significantly to 55.8% (71.3% in nondepressed patients, P < .001). Classification performance was not impacted by motor symptoms. The estimated classification performances and predictive values correspond to those reported previously for non-PD populations. Our results indicate that CDT is a suitable screening instrument in patients with PD, but test results from patients with depression warrant careful consideration.
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Affiliation(s)
- Oliver Riedel
- Technische Universitaet Dresden, Institute of Clinical Psychology and Psychotherapy, Germany
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Marianetti M, Izzo C, Fratino M, Mina C. Single strategic infarct dementia mimicking dementia with Lewy bodies. J Am Geriatr Soc 2010; 58:2432-3. [PMID: 21143448 DOI: 10.1111/j.1532-5415.2010.03186.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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