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Levy G, Levin B, Engelhardt E. Advancing the Genetics of Lewy Body Disorders with Disease-Modifying Treatments in Mind. ADVANCED GENETICS (HOBOKEN, N.J.) 2022; 3:2200011. [PMID: 36911298 PMCID: PMC9993470 DOI: 10.1002/ggn2.202200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/13/2022] [Indexed: 11/06/2022]
Abstract
In this article, a caveat for advancing the genetics of Lewy body disorders is raised, given the nosological controversy about whether to consider dementia with Lewy bodies (DLB) and Parkinson's disease (PD) as one entity or two separate entities. Using the framework of the sufficient and component causes model of causation, as further developed into an evolution-based model of causation, it is proposed that a disease of complex etiology is defined as having a relatively high degree of sharing of the component causes (a genetic or environmental factor), that is, a low degree of heterogeneity of the sufficient causes. Based on this definition, only if the sharing of component causes within each of two diseases is similar to their combined sharing can lumping be warranted. However, it is not known whether the separate and combined sharing are similar before conducting the etiologic studies. This means that lumping DLB and PD can be counterproductive as it can decrease the ability to detect component causes despite the potential benefit of conducting studies with larger sample sizes. In turn, this is relevant to the development of disease-modifying treatments, because non-overlapping causal genetic factors may result in distinct pathogenetic pathways providing promising targets for interventions.
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Affiliation(s)
| | - Bruce Levin
- Department of BiostatisticsMailman School of Public HealthColumbia UniversityNew York10032USA
| | - Eliasz Engelhardt
- Instituto de Neurologia Deolindo Couto and Instituto de PsiquiatriaUniversidade Federal do Rio de JaneiroRio de Janeiro22290‐140Brazil
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2
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Hemminghyth MS, Chwiszczuk LJ, Rongve A, Breitve MH. The Cognitive Profile of Mild Cognitive Impairment Due to Dementia With Lewy Bodies-An Updated Review. Front Aging Neurosci 2021; 12:597579. [PMID: 33424578 PMCID: PMC7785712 DOI: 10.3389/fnagi.2020.597579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/19/2020] [Indexed: 01/06/2023] Open
Abstract
Objective: Dementia with Lewy Bodies (DLB) is the second most common type of neurodegenerative dementia. Yet, the domain-specific cognitive impairment of the mild cognitive impairment (MCI) phase of this disease (DLB-MCI) is still not been established. This article gives an updated review on the neuropsychological profile of DLB-MCI, building on the findings from a previous review. Methods: We performed systematic review and searched five different electronic databases (Scopus, Cochrane, EMBASE, MEDLINE, and PsycINFO) in May 2020 based on a PICO scheme. Our search was then restricted to articles published in 2019 and 2020. Ending up with a total of 90 articles to be reviewed by abstract and/or full text. Results: In total four papers were included, whereof only one met our full inclusion criteria. Despite a substantial heterogeneity, our findings indicate that DLB-MCI patients have a pattern of executive, visuospatial, and attentional deficits. Conclusion: The findings indicate that the neuropsychological profile of DLB-MCI is characterized by executive, visuospatial, and attentional deficits. Furthermore, the shortage of studies clearly underlines the paucity of published research into DLB-MCI and emphasizes the need for well-controlled studies.
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Affiliation(s)
| | | | - Arvid Rongve
- Research Group for Age-Related Medicine, Haugesund Hospital, Haugesund, Norway.,Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
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3
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Levy G, Levin B, Engelhardt E. The Nosology of Lewy Body Disorders From Analytic-Epidemiologic and Statistical Vantage Points. Mov Disord 2020; 35:2156-2161. [PMID: 32936973 DOI: 10.1002/mds.28288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Eliasz Engelhardt
- Behavioral and Cognitive Neurology Unit, Neurological Institute, Center for Alzheimer's Disease, Psychiatric Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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4
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Connors MH, Quinto L, McKeith I, Brodaty H, Allan L, Bamford C, Thomas A, Taylor JP, O'Brien JT. Non-pharmacological interventions for Lewy body dementia: a systematic review. Psychol Med 2018; 48:1749-1758. [PMID: 29143692 PMCID: PMC6088773 DOI: 10.1017/s0033291717003257] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/05/2017] [Indexed: 01/15/2023]
Abstract
Lewy body dementia (consisting of dementia with Lewy bodies and Parkinson's disease dementia) is a common neurodegenerative disease characterised by visual hallucinations, fluctuating attention, motor disturbances, falls, and sensitivity to antipsychotics. This combination of features presents challenges for pharmacological management. Given this, we sought to review evidence for non-pharmacological interventions with patients with Lewy body dementia and their carers. Bibliographic databases were searched using a wide range of search terms and no restrictions were placed on study design, language, or clinical setting. Two reviewers independently assessed papers for inclusion, rated study quality, and extracted data. The search identified 21 studies including two randomised controlled trials with available subgroup data, seven case series, and 12 case studies. Most studies reported beneficial effects of the interventions used, though the only sizeable study was on dysphagia, showing a benefit of honey-thickened liquids. Given the heterogeneity of interventions and poor quality of the studies overall, no quantitative synthesis was possible. Overall, identified studies suggested possible benefits of non-pharmacological interventions in Lewy body dementia, but the small sample sizes and low quality of studies mean no definite recommendations can be offered. Our findings underscore the clear and urgent need for future research on this topic.
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Affiliation(s)
- Michael H. Connors
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Dementia Centre for Research Collaboration, UNSW Sydney, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, NSW, Australia
| | - Lena Quinto
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Ian McKeith
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, UNSW Sydney, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, NSW, Australia
| | - Louise Allan
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Alan Thomas
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom
| | - John T. O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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5
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Jellinger KA. Dementia with Lewy bodies and Parkinson's disease-dementia: current concepts and controversies. J Neural Transm (Vienna) 2017; 125:615-650. [PMID: 29222591 DOI: 10.1007/s00702-017-1821-9] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/28/2017] [Indexed: 12/15/2022]
Abstract
Dementia with Lewy bodies (DLB) and Parkinson's disease-dementia (PDD), although sharing many clinical, neurochemical and morphological features, according to DSM-5, are two entities of major neurocognitive disorders with Lewy bodies of unknown etiology. Despite considerable clinical overlap, their diagnosis is based on an arbitrary distinction between the time of onset of motor and cognitive symptoms: dementia often preceding parkinsonism in DLB and onset of cognitive impairment after onset of motor symptoms in PDD. Both are characterized morphologically by widespread cortical and subcortical α-synuclein/Lewy body plus β-amyloid and tau pathologies. Based on recent publications, including the fourth consensus report of the DLB Consortium, a critical overview is given. The clinical features of DLB and PDD include cognitive impairment, parkinsonism, visual hallucinations, and fluctuating attention. Intravitam PET and post-mortem studies revealed more pronounced cortical atrophy, elevated cortical and limbic Lewy pathologies (with APOE ε4), apart from higher prevalence of Alzheimer pathology in DLB than PDD. These changes may account for earlier onset and greater severity of cognitive defects in DLB, while multitracer PET studies showed no differences in cholinergic and dopaminergic deficits. DLB and PDD sharing genetic, neurochemical, and morphologic factors are likely to represent two subtypes of an α-synuclein-associated disease spectrum (Lewy body diseases), beginning with incidental Lewy body disease-PD-nondemented-PDD-DLB (no parkinsonism)-DLB with Alzheimer's disease (DLB-AD) at the most severe end, although DLB does not begin with PD/PDD and does not always progress to DLB-AD, while others consider them as the same disease. Both DLB and PDD show heterogeneous pathology and neurochemistry, suggesting that they share important common underlying molecular pathogenesis with AD and other proteinopathies. Cognitive impairment is not only induced by α-synuclein-caused neurodegeneration but by multiple regional pathological scores. Recent animal models and human post-mortem studies have provided important insights into the pathophysiology of DLB/PDD showing some differences, e.g., different spreading patterns of α-synuclein pathology, but the basic pathogenic mechanisms leading to the heterogeneity between both disorders deserve further elucidation. In view of the controversies about the nosology and pathogenesis of both syndromes, there remains a pressing need to differentiate them more clearly and to understand the processes leading these synucleinopathies to cause one disorder or the other. Clinical management of both disorders includes cholinesterase inhibitors, other pharmacologic and nonpharmacologic strategies, but these have only a mild symptomatic effect. Currently, no disease-modifying therapies are available.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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6
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Datta A, Chai YL, Tan JM, Lee JH, Francis PT, Chen CP, Sze SK, Lai MKP. An iTRAQ-based proteomic analysis reveals dysregulation of neocortical synaptopodin in Lewy body dementias. Mol Brain 2017; 10:36. [PMID: 28800743 PMCID: PMC5553757 DOI: 10.1186/s13041-017-0316-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/21/2017] [Indexed: 02/08/2023] Open
Abstract
Lewy body dementias are the second most common cause of neurodegenerative dementia in the elderly after Alzheimer's disease (AD). The two clinical subgroups of Lewy body dementias, namely, dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), are differentiated by the chronology of cognitive symptoms relative to parkinsonism. At present, there remains a debate on whether DLB and PDD are separate disease entities, or fall within the same spectrum of Lewy body dementias. In this study, we compared the detergent-soluble proteome via an 8-plex isobaric tag for relative and absolute quantitation (iTRAQ) analysis of pooled lysates from the prefrontal cortex (BA9) of DLB (n = 19) and PDD (n = 21) patients matched a priori for amyloid (total Aβ42) burden, semi-quantitative scores for Lewy bodies and neurofibrillary tangles together with age-matched control (n = 21) subjects. A total of 1914 proteins were confidently identified by iTRAQ (false discovery rate = 0%). None of the proteins showed a significant yet opposite regulation in between DLB and PDD when compared to aged controls in the proteomic data set as well as following immunoblot analysis of the pooled and individual lysates involving all 61 subjects. The postsynaptic protein, synaptopodin (SYNPO) was significantly down-regulated in both DLB and PDD subgroups, suggesting a defective synaptic transmission in the demented patients. In conclusion, the largely similar proteome of DLB and PDD matched for amyloid burden suggests that variations in concomitant AD-related pathology, abnormal post-translational modifications or protein-protein interactions, defective intracellular trafficking or misfolding of proteins could play a part in driving the clinically observed differences between these two subgroups of Lewy body dementias. This further indicates that amyloid-targeting therapeutic strategies may show different efficacies in DLB versus PDD.
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Affiliation(s)
- Arnab Datta
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Unit 09-01, Centre for Translational Medicine (MD6), 14 Medical Drive, Kent Ridge, Singapore 117599, Singapore. .,Epithelial Systems Biology Laboratory, National Heart, Lung, and Blood Institute, Building 10 Room 6N318, Bethesda, MD 20814, USA.
| | - Yuek Ling Chai
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Unit 09-01, Centre for Translational Medicine (MD6), 14 Medical Drive, Kent Ridge, Singapore 117599, Singapore
| | - Jing Min Tan
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Unit 09-01, Centre for Translational Medicine (MD6), 14 Medical Drive, Kent Ridge, Singapore 117599, Singapore
| | - Jasinda H Lee
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Unit 09-01, Centre for Translational Medicine (MD6), 14 Medical Drive, Kent Ridge, Singapore 117599, Singapore
| | - Paul T Francis
- Wolfson Centre for Age-related Diseases, King's College London, Guy's Campus, St Thomas Street, London SE1 1UL, UK
| | - Christopher P Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Unit 09-01, Centre for Translational Medicine (MD6), 14 Medical Drive, Kent Ridge, Singapore 117599, Singapore
| | - Siu Kwan Sze
- School of Biological Sciences, Nanyang Technological University, Singapore 637551, Singapore
| | - Mitchell K P Lai
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Unit 09-01, Centre for Translational Medicine (MD6), 14 Medical Drive, Kent Ridge, Singapore 117599, Singapore. .,Wolfson Centre for Age-related Diseases, King's College London, Guy's Campus, St Thomas Street, London SE1 1UL, UK.
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7
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Scharre DW, Chang SI, Nagaraja HN, Park A, Adeli A, Agrawal P, Kloos A, Kegelmeyer D, Linder S, Fritz N, Kostyk SK, Kataki M. Paired Studies Comparing Clinical Profiles of Lewy Body Dementia with Alzheimer’s and Parkinson’s Diseases. J Alzheimers Dis 2016; 54:995-1004. [DOI: 10.3233/jad-160384] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Shu-Ing Chang
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Haikady N. Nagaraja
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Ariane Park
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Anahita Adeli
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Punit Agrawal
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Anne Kloos
- Physical Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Deb Kegelmeyer
- Physical Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Shannon Linder
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Nora Fritz
- Physical Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Sandra K. Kostyk
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Maria Kataki
- Department of Neurology, The Ohio State University, Columbus, OH, USA
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8
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Chiu PY, Tsai CT, Chen PK, Chen WJ, Lai TJ. Neuropsychiatric Symptoms in Parkinson's Disease Dementia Are More Similar to Alzheimer's Disease than Dementia with Lewy Bodies: A Case-Control Study. PLoS One 2016; 11:e0153989. [PMID: 27101140 PMCID: PMC4839640 DOI: 10.1371/journal.pone.0153989] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/06/2016] [Indexed: 11/30/2022] Open
Abstract
Background and purpose Previous studies on the clinical and pathological manifestations of Parkinson’s disease dementia (PDD) have reported findings more similar to dementia with Lewy bodies (DLB) than to Alzheimer’s disease (AD). The aim of this study was to investigate the neuropsychiatric symptoms of PDD compared to DLB and AD. Methods We conducted a retrospective case-control study on 125 newly diagnosed consecutive PDD patients and age- and dementia stage-matched controls with either DLB (N = 250) or AD (N = 500) who visited the same hospital over the same period. For each case and control, neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory (NPI). Results Overall, 513 (58.6%) patients were female and 362 (41.4%) were male. Comparisons of clinical data revealed that the PDD group, similar to the AD group, had a lower NPI total score, NPI caregiver burden score, and rate of antipsychotic use (all p < 0.001) than the DLB group. One or more psychiatric symptoms were reported in 95.2% of the PDD, 99.2% of the DLB, and 96.8% of the AD patients. The PDD group had lower subscores in the items of delusions, hallucinations, agitation, anxiety, irritation, aberrant motor behavior compared to the DLB group. Severe neuropsychiatric symptoms among all dementia patients were associated with younger age, more advanced stage, and a diagnosis of DLB. Conclusion Neuropsychiatric symptoms in PDD were more like those in AD than in DLB. Severe neuropsychiatric symptoms in degenerative dementia were associated with younger age, more advanced stage of dementia, and a diagnosis of DLB.
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Affiliation(s)
- Pai-Yi Chiu
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Neurology, Show-Chwan Memorial Hospital, Changhua, Taiwan
| | - Chun-Tang Tsai
- Department of Guidance and Counseling, National Changhua University of Education, Changhua, Taiwan
| | - Ping-Kun Chen
- Department of Neurology, Lin-Shin Hospital, Taichung, Taiwan
| | - Whe-Jen Chen
- Department of Neurology, Lin-Shin Hospital, Taichung, Taiwan
| | - Te-Jen Lai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan
- * E-mail:
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9
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Chimagomedova AS, Levin OS. Orthostatic hypotension in dementia with Lewy bodies. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:54-59. [DOI: 10.17116/jnevro20161166254-59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Donaghy P, Thomas AJ, O'Brien JT. Amyloid PET Imaging in Lewy body disorders. Am J Geriatr Psychiatry 2015; 23:23-37. [PMID: 23831180 DOI: 10.1016/j.jagp.2013.03.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 02/19/2013] [Accepted: 03/01/2013] [Indexed: 11/25/2022]
Abstract
Lewy body (LB) disorders, including Parkinson disease (PD), Parkinson disease dementia (PDD), and dementia with Lewy bodies (DLB), are the second most common type of neurodegenerative dementia. Although the pathological hallmarks of LB disorders are Lewy bodies and Lewy neurites, cortical amyloid-beta (Aβ) deposition is also often seen. The relationship between Aβ pathology and dementia in LB disorders is unclear. Recently, positron emission tomography Aβ ligands have been developed that enable in vivo imaging of Aβ. In this paper we review amyloid imaging studies in LB disorders. LB disorders are associated with lower mean cortical Aβ ligand binding compared with Alzheimer disease. In DLB and PDD many subjects have normal levels of cortical Aβ, though a subset show increased Aβ ligand binding. Those with DLB show greater ligand binding than PDD; binding does not appear to be increased in PD without dementia. Cortical Aβ deposition may be a factor in the development of cognitive impairment in some cases of dementia in LB disorders. Amyloid imaging is of limited use in the diagnosis of LB disorders but Aβ deposition may predict the future development of dementia in PD. Reports of correlation between Aβ deposition and symptom profile, severity, and progression have been inconsistent. Some results suggest a synergistic interaction between Aβ and α-synuclein. Interpretation of the current evidence is hampered by differing methodologies across studies and small sample sizes. Large, prospective longitudinal studies are needed to clarify the association of Aβ with symptom development, progression, severity, and treatment response in LB disorders.
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Affiliation(s)
- Paul Donaghy
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom.
| | - Alan J Thomas
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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11
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Donaghy PC, McKeith IG. The clinical characteristics of dementia with Lewy bodies and a consideration of prodromal diagnosis. ALZHEIMERS RESEARCH & THERAPY 2014; 6:46. [PMID: 25484925 PMCID: PMC4255387 DOI: 10.1186/alzrt274] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Dementia with Lewy bodies (DLB) is the second most common type of degenerative dementia following Alzheimer’s disease (AD). DLB is clinically and pathologically related to Parkinson's disease (PD) and PD dementia, and the three disorders can be viewed as existing on a spectrum of Lewy body disease. In recent years there has been a concerted effort to establish the phenotypes of AD and PD in the prodromal phase (before the respective syndromes of cognitive and motor impairment are expressed). Evidence for the prodromal presentation of DLB is also emerging. This paper briefly reviews what is known about the clinical presentation of prodromal DLB before discussing the pathology of Lewy body disease and how this relates to potential biomarkers of prodromal DLB. The presenting features of DLB can be broadly placed in three categories: cognitive impairment (particularly nonamnestic cognitive impairments), behavioural/psychiatric phenomena (for example, hallucinations, rapid eye movement sleep behaviour disorder (RBD)) and physical symptoms (for example, parkinsonism, decreased sense of smell, autonomic dysfunction). Some noncognitive symptoms such as constipation, RBD, hyposmia and postural dizziness can predate the onset of memory impairment by several years in DLB. Pathological studies of Lewy body disease have found that the earliest sites of involvement are the olfactory bulb, the dorsal motor nucleus of the vagal nerve, the peripheral autonomic nervous system, including the enteric nervous system, and the brainstem. Some of the most promising early markers for DLB include the presence of RBD, autonomic dysfunction or hyposmia, 123I-metaiodobenzylguanidine cardiac scintigraphy, measures of substantia nigra pathology and skin biopsy for α-synuclein in peripheral autonomic nerves. In the absence of disease-modifying therapies, the diagnosis of prodromal DLB is of limited use in the clinic. That said, knowledge of the prodromal development of DLB could help clinicians identify cases of DLB where the diagnosis is uncertain. Prodromal diagnosis is of great importance in research, where identifying Lewy body disease at an earlier stage may allow researchers to investigate the initial phases of dementia pathophysiology, develop treatments designed to interrupt the development of the dementia syndrome and accurately identify the patients most likely to benefit from these treatments.
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Affiliation(s)
- Paul C Donaghy
- Level 3, Biomedical Research Building, Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle NE4 5PL, UK
| | - Ian G McKeith
- Level 3, Biomedical Research Building, Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle NE4 5PL, UK
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12
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Berg D, Postuma RB, Bloem B, Chan P, Dubois B, Gasser T, Goetz CG, Halliday GM, Hardy J, Lang AE, Litvan I, Marek K, Obeso J, Oertel W, Olanow CW, Poewe W, Stern M, Deuschl G. Time to redefine PD? Introductory statement of the MDS Task Force on the definition of Parkinson's disease. Mov Disord 2014; 29:454-62. [PMID: 24619848 PMCID: PMC4204150 DOI: 10.1002/mds.25844] [Citation(s) in RCA: 314] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 11/27/2013] [Accepted: 12/03/2013] [Indexed: 12/12/2022] Open
Abstract
With advances in knowledge disease, boundaries may change. Occasionally, these changes are of such a magnitude that they require redefinition of the disease. In recognition of the profound changes in our understanding of Parkinson's disease (PD), the International Parkinson and Movement Disorders Society (MDS) commissioned a task force to consider a redefinition of PD. This review is a discussion article, intended as the introductory statement of the task force. Several critical issues were identified that challenge current PD definitions. First, new findings challenge the central role of the classical pathologic criteria as the arbiter of diagnosis, notably genetic cases without synuclein deposition, the high prevalence of incidental Lewy body (LB) deposition, and the nonmotor prodrome of PD. It remains unclear, however, whether these challenges merit a change in the pathologic gold standard, especially considering the limitations of alternate gold standards. Second, the increasing recognition of dementia in PD challenges the distinction between diffuse LB disease and PD. Consideration might be given to removing dementia as an exclusion criterion for PD diagnosis. Third, there is increasing recognition of disease heterogeneity, suggesting that PD subtypes should be formally identified; however, current subtype classifications may not be sufficiently robust to warrant formal delineation. Fourth, the recognition of a nonmotor prodrome of PD requires that new diagnostic criteria for early-stage and prodromal PD should be created; here, essential features of these criteria are proposed. Finally, there is a need to create new MDS diagnostic criteria that take these changes in disease definition into consideration.
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Affiliation(s)
- Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Center of Neurodegenerative DiseasesTuebingen, Germany
| | - Ronald B Postuma
- Department of Neurology, Montreal General HospitalMontreal, Quebec, Canada
| | - Bastiaan Bloem
- Department of Neurology, Radboud University Nijmegen Medical CenterNijmegen, the Netherlands
| | - Piu Chan
- Xuanwu Hospital of Capital Medical UniversityBeijing, People's Republic of China
| | - Bruno Dubois
- Department of neurology, Salpêtrière Hospital, APHP, University Paris 6UPMC, Paris, France
| | - Thomas Gasser
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and German Center of Neurodegenerative DiseasesTuebingen, Germany
| | | | - Glenda M Halliday
- Neuroscience Research, Randwick, Australia and the University of New South WalesSydney, Australia
| | - John Hardy
- Department of Molecular Neuroscience, UCL Institute of NeurologyLondon, UK
| | - Anthony E Lang
- Edmond J Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital and the University of TorontoToronto, Canada
| | - Irene Litvan
- Department of Neurosciences, University of California San DiegoLa Jolla, California, USA
| | - Kenneth Marek
- Institute for Neurodegenerative DisordersNew Haven, Connecticut, USA
| | - José Obeso
- University of Navarra-FIMAPamplona, Spain
| | - Wolfgang Oertel
- Department of Neurology, Philipps University of MarburgMarburg, Germany
| | - C Warren Olanow
- Department of Neurology, The Mount Sinai HospitalNew York, New York, USA
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical UniversityInnsbruck, Austria
| | - Matthew Stern
- Penn Neurological InstitutePhiladelphia, Pennsylvania, USA
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts UniversityKiel, Germany
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13
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Gray matter atrophy in Parkinson’s disease with dementia: evidence from meta-analysis of voxel-based morphometry studies. Neurol Sci 2012. [DOI: 10.1007/s10072-012-1250-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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Postuma RB, Aarsland D, Barone P, Burn DJ, Hawkes CH, Oertel W, Ziemssen T. Identifying prodromal Parkinson's disease: pre-motor disorders in Parkinson's disease. Mov Disord 2012; 27:617-26. [PMID: 22508280 DOI: 10.1002/mds.24996] [Citation(s) in RCA: 390] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Increasing recognition that Parkinson's disease (PD) may start outside of the substantia nigra has led to a rapidly expanding effort to define prodromal stages of PD, before motor signs permit classical diagnosis. Many of these efforts center around the identification of clinical non-motor symptoms and signs of disease. There is now direct evidence that olfaction, rapid eye movement (REM) sleep behavior disorder (RBD), constipation, and depression can be present in prodromal PD. In addition, there is suggestive evidence that visual changes, other autonomic symptoms, and subtle cognitive changes may also be present at prodromal stages. A critical issue in utility of these prodromal markers will be assessment of sensitivity, specificity, and positive and negative predictive values. Although these have yet to be fully defined, olfactory deficits, some visual changes, and autonomic symptoms occur in the majority of PD patients at diagnosis, suggesting good potential sensitivity. However, with the exception of RBD and perhaps some specific autonomic measures, specificity, and positive predictive value of these markers may be insufficient to be used alone as identifiers of prodromal disease. The evidence for the utility of olfaction, RBD, autonomic markers, visual changes, mood disorders, and cognitive loss as markers of prodromal PD and the potential sensitivity and specificity of these markers are summarized.
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Affiliation(s)
- Ronald B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada.
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A précis of recent advances in the neuropsychology of mild cognitive impairment(s) in Parkinson's disease and a proposal of preliminary research criteria. J Int Neuropsychol Soc 2011; 17:393-406. [PMID: 21473805 DOI: 10.1017/s1355617711000257] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cognitive changes of Parkinson's disease (PD) manifest earlier and are more heterogeneous than previously appreciated. Approximately one-third of patients have at least mild cognitive changes at PD diagnosis, and subtle changes might be appreciable among those at risk for PD. Executive dysfunction is the most common cognitive change, but other phenotypes exist. Pathobiologic and potential prognostic differences among cognitive phenotypes remain poorly understood. Progress in the neuropsychology, epidemiology and pathobiology of mild cognitive impairment (MCI) in PD is hampered by lack of diagnostic criteria. This study proposes preliminary research criteria for two categories of PD non-dementia cognitive impairment.
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Neuropsychological and clinical heterogeneity of cognitive impairment and dementia in patients with Parkinson's disease. Lancet Neurol 2010; 9:1200-1213. [PMID: 20880750 DOI: 10.1016/s1474-4422(10)70212-x] [Citation(s) in RCA: 613] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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