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Bălăeţ M, Alhajraf F, Zerenner T, Welch J, Razzaque J, Lo C, Giunchiglia V, Trender W, Lerede A, Hellyer PJ, Manohar SG, Malhotra P, Hu M, Hampshire A. Online cognitive monitoring technology for people with Parkinson's disease and REM sleep behavioural disorder. NPJ Digit Med 2024; 7:118. [PMID: 38714742 PMCID: PMC11076465 DOI: 10.1038/s41746-024-01124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/23/2024] [Indexed: 05/10/2024] Open
Abstract
Automated online cognitive assessments are set to revolutionise clinical research and healthcare. However, their applicability for Parkinson's Disease (PD) and REM Sleep Behavioural Disorder (RBD), a strong PD precursor, is underexplored. Here, we developed an online battery to measure early cognitive changes in PD and RBD. Evaluating 19 candidate tasks showed significant global accuracy deficits in PD (0.65 SD, p = 0.003) and RBD (0.45 SD, p = 0.027), driven by memory, language, attention and executive underperformance, and global reaction time deficits in PD (0.61 SD, p = 0.001). We identified a brief 20-min battery that had sensitivity to deficits across these cognitive domains while being robust to the device used. This battery was more sensitive to early-stage and prodromal deficits than the supervised neuropsychological scales. It also diverged from those scales, capturing additional cognitive factors sensitive to PD and RBD. This technology offers an economical and scalable method for assessing these populations that can complement standard supervised practices.
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Affiliation(s)
- Maria Bălăeţ
- Department of Brain Sciences, Imperial College London, London, UK.
| | - Falah Alhajraf
- Oxford Parkinson's Disease Centre, Nuffield Department Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Tanja Zerenner
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jessica Welch
- Oxford Parkinson's Disease Centre, Nuffield Department Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jamil Razzaque
- Oxford Parkinson's Disease Centre, Nuffield Department Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Christine Lo
- Oxford Parkinson's Disease Centre, Nuffield Department Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - William Trender
- Department of Brain Sciences, Imperial College London, London, UK
| | - Annalaura Lerede
- Department of Brain Sciences, Imperial College London, London, UK
| | - Peter J Hellyer
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sanjay G Manohar
- Oxford Parkinson's Disease Centre, Nuffield Department Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paresh Malhotra
- Department of Brain Sciences, Imperial College London, London, UK
| | - Michele Hu
- Oxford Parkinson's Disease Centre, Nuffield Department Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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2
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Bramich S, Noyce AJ, King AE, Naismith SL, Kuruvilla MV, Lewis SJG, Roccati E, Bindoff AD, Barnham KJ, Beauchamp LC, Vickers JC, Pérez-Carbonell L, Alty J. Isolated rapid eye movement sleep behaviour disorder (iRBD) in the Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) Sleep Study: protocol and baseline characteristics. J Sleep Res 2024; 33:e14109. [PMID: 38014898 DOI: 10.1111/jsr.14109] [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: 07/04/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
Isolated rapid eye movement (REM) sleep behaviour disorder (iRBD) is a sleep disorder that is characterised by dream enactment episodes during REM sleep. It is the strongest known predictor of α-synuclein-related neurodegenerative disease (αNDD), such that >80% of people with iRBD will eventually develop Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy in later life. More research is needed to understand the trajectory of phenoconversion to each αNDD. Only five 'gold standard' prevalence studies of iRBD in older adults have been undertaken previously, with estimates ranging from 0.74% to 2.01%. The diagnostic recommendations for video-polysomnography (vPSG) to confirm iRBD makes prevalence studies challenging, as vPSG is often unavailable to large cohorts. In Australia, there have been no iRBD prevalence studies, and little is known about the cognitive and motor profiles of Australian people with iRBD. The Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) Sleep Study will investigate the prevalence of iRBD in Tasmania, an island state of Australia, using validated questionnaires and home-based vPSG. It will also explore several cognitive, motor, olfactory, autonomic, visual, tactile, and sleep profiles in people with iRBD to better understand which characteristics influence the progression of iRBD to αNDD. This paper details the ISLAND Sleep Study protocol and presents preliminary baseline results.
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Affiliation(s)
- Samantha Bramich
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Alastair J Noyce
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University, London, UK
| | - Anna E King
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | | | - Simon J G Lewis
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Eddy Roccati
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Aidan D Bindoff
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Kevin J Barnham
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Leah C Beauchamp
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James C Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Laura Pérez-Carbonell
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University, London, UK
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
- Department of Neurology, Royal Hobart Hospital, Hobart, Australia
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3
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Leitner C, D'Este G, Verga L, Rahayel S, Mombelli S, Sforza M, Casoni F, Zucconi M, Ferini-Strambi L, Galbiati A. Neuropsychological Changes in Isolated REM Sleep Behavior Disorder: A Systematic Review and Meta-analysis of Cross-sectional and Longitudinal Studies. Neuropsychol Rev 2024; 34:41-66. [PMID: 36588140 DOI: 10.1007/s11065-022-09572-1] [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: 05/31/2022] [Accepted: 11/28/2022] [Indexed: 01/03/2023]
Abstract
The aim of this meta-analysis is twofold: (a) to assess cognitive impairments in isolated rapid eye movement (REM) sleep behavior disorder (iRBD) patients compared to healthy controls (HC); (b) to quantitatively estimate the risk of developing a neurodegenerative disease in iRBD patients according to baseline cognitive assessment. To address the first aim, cross-sectional studies including polysomnography-confirmed iRBD patients, HC, and reporting neuropsychological testing were included. To address the second aim, longitudinal studies including polysomnography-confirmed iRBD patients, reporting baseline neuropsychological testing for converted and still isolated patients separately were included. The literature search was conducted based on PRISMA guidelines and the protocol was registered at PROSPERO (CRD42021253427). Cross-sectional and longitudinal studies were searched from PubMed, Web of Science, Scopus, and Embase databases. Publication bias and statistical heterogeneity were assessed respectively by funnel plot asymmetry and using I2. Finally, a random-effect model was performed to pool the included studies. 75 cross-sectional (2,398 HC and 2,460 iRBD patients) and 11 longitudinal (495 iRBD patients) studies were selected. Cross-sectional studies showed that iRBD patients performed significantly worse in cognitive screening scores (random-effects (RE) model = -0.69), memory (RE model = -0.64), and executive function (RE model = -0.50) domains compared to HC. The survival analyses conducted for longitudinal studies revealed that lower executive function and language performance, as well as the presence of mild cognitive impairment (MCI), at baseline were associated with an increased risk of conversion at follow-up. Our study underlines the importance of a comprehensive neuropsychological assessment in the context of iRBD.
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Affiliation(s)
- Caterina Leitner
- "Vita-Salute" San Raffaele University, Milan, Italy
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Giada D'Este
- "Vita-Salute" San Raffaele University, Milan, Italy
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Laura Verga
- Comparative Bioacoustics Group, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
- Faculty of Psychology and Neuroscience, Department NP&PP, Maastricht University, Maastricht, The Netherlands
| | - Shady Rahayel
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal - Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Samantha Mombelli
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Marco Sforza
- "Vita-Salute" San Raffaele University, Milan, Italy
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Francesca Casoni
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Marco Zucconi
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Luigi Ferini-Strambi
- "Vita-Salute" San Raffaele University, Milan, Italy
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Andrea Galbiati
- "Vita-Salute" San Raffaele University, Milan, Italy.
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy.
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4
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Kim H, Seo P, Kim MJ, Huh JI, Sunwoo JS, Cha KS, Jeong E, Kim HJ, Jung KY, Kim KH. Characterization of attentional event-related potential from REM sleep behavior disorder patients based on explainable machine learning. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 234:107496. [PMID: 36972628 DOI: 10.1016/j.cmpb.2023.107496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 02/20/2023] [Accepted: 03/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Idiopathic rapid eye movement sleep behavior disorder (iRBD) is a prodromal stage of neurodegeneration and is associated with cortical dysfunction. The purpose of this study was to investigate the spatiotemporal characteristics of cortical activities underlying impaired visuospatial attention in iRBD patients using an explainable machine-learning approach. METHODS An algorithm based on a convolutional neural network (CNN) was devised to discriminate cortical current source activities of iRBD patients due to single-trial event-related potentials (ERPs), from those of normal controls. The ERPs from 16 iRBD patients and 19 age- and sex-matched normal controls were recorded while the subjects were performing visuospatial attentional task, and converted to two-dimensional images representing current source densities on flattened cortical surface. The CNN classifier was trained based on overall data, and then, a transfer learning approach was applied for the fine-tuning to each patient. RESULTS The trained classifier yielded high classification accuracy. The critical features for the classification were determined by layer-wise relevance propagation, so that the spatiotemporal characteristics of cortical activities that were most relevant to cognitive impairment in iRBD were revealed. CONCLUSIONS These results suggest that the recognized dysfunction in visuospatial attention of iRBD patients originates from neural activity impairment in relevant cortical regions and may contribute to the development of useful iRBD biomarkers based on neural activity.
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Affiliation(s)
- Hyun Kim
- Department of Biomedical Engineering College of Health Science, Yonsei University, 234 Maeji-ri, Heungup-myun, Wonju, Gangwon-do 220-710, South Korea
| | - Pukyeong Seo
- Department of Biomedical Engineering College of Health Science, Yonsei University, 234 Maeji-ri, Heungup-myun, Wonju, Gangwon-do 220-710, South Korea
| | - Min Ju Kim
- Department of Biomedical Engineering College of Health Science, Yonsei University, 234 Maeji-ri, Heungup-myun, Wonju, Gangwon-do 220-710, South Korea
| | - Jun Il Huh
- Department of Biomedical Engineering College of Health Science, Yonsei University, 234 Maeji-ri, Heungup-myun, Wonju, Gangwon-do 220-710, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Kangbuk Samsung Hospital, Seoul, South Korea
| | - Kwang Su Cha
- Department of Neurology Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - El Jeong
- Interdisciplinary Program in Bioengineering College of Engineering, Seoul National University, Seoul, South Korea
| | - Han-Joon Kim
- Department of Neurology Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Ki-Young Jung
- Department of Neurology Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul 03080, South Korea.
| | - Kyung Hwan Kim
- Department of Biomedical Engineering College of Health Science, Yonsei University, 234 Maeji-ri, Heungup-myun, Wonju, Gangwon-do 220-710, South Korea.
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Mombelli S, Leitner C, D'Este G, Sforza M, Marelli S, Castelnuovo A, Zucconi M, Casoni F, Fantini ML, Novellino F, Salsone M, Ferini-Strambi L, Galbiati A. A data-driven approach to neuropsychological features in isolated REM behaviour disorder: A latent class analysis. J Neuropsychol 2023; 17:161-179. [PMID: 36192363 DOI: 10.1111/jnp.12292] [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: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
Recent evidence demonstrated that neuropsychological assessment may be considered a valid marker of neurodegeneration in idiopathic REM sleep behaviour disorder (iRBD). However, little is known about the possible neuropsychological heterogeneity within the iRBD population. This retrospective study aimed to identify and describe different neuropsychological phenotypes in iRBD patients by means of a data-driven approach using latent class analysis. A total of 289 iRBD patients underwent a neuropsychological assessment evaluating cognitive domains: global cognition, language, short- and long-term memory, executive functions and visuospatial abilities. The presence of mild cognitive impairment (MCI) was also assessed. Latent class analysis was carried out to identify iRBD subtypes according to neuropsychological scores. The most parsimonious model identified three latent classes. Groups were labelled as follows: Class 2 "severely impaired" (n = 83/289): mean pathological scores in different tests, a high percentage of MCI multiple-domain and impairment in all neuropsychological domains. Class 1 "moderately impaired" (n = 44/289): mean neuropsychological score within the normal value, a high percentage of MCI (high risk to phenoconversion) and great impairment in the visuospatial domain. Class 3 "slightly impaired" (n = 162/289): no deficit worthy of attention except for short- and long-term memory. Our results suggest three different clinical phenotypes within the iRBD population. These findings may be relevant in the future for predicting the clinical trajectories of phenoconversion in iRBD.
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Affiliation(s)
- Samantha Mombelli
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Leitner
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
| | - Giada D'Este
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
| | - Marco Sforza
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
| | - Sara Marelli
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Castelnuovo
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Zucconi
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Casoni
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Livia Fantini
- Sleep and EEG, Neurophysiology Unit, Clermont-Ferrand University Hospital and UMR 6602 - Université Clermont Auvergne, CNRS, Institut Pascal, Clermont-Ferrand, France
| | - Fabiana Novellino
- Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council, Catanzaro, Italy.,Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Investigación Neuroquímica (IUINQ-UCM), Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
| | - Maria Salsone
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy.,Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council, Catanzaro, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
| | - Andrea Galbiati
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.,"Vita-Salute" San Raffaele University, Milan, Italy
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6
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Wenke Š, Mana J, Havlík F, Cohn M, Nikolai T, Buschke H, Nepožitek J, Peřinová P, Dostálová S, Ibarburu Lorenzo Y Losada V, Růžička E, Šonka K, Dušek P, Bezdicek O. Characterization of memory profile in idiopathic REM sleep behavior disorder. J Clin Exp Neuropsychol 2022; 44:237-250. [DOI: 10.1080/13803395.2022.2107182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Štěpán Wenke
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Josef Mana
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Filip Havlík
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Melanie Cohn
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Tomáš Nikolai
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Herman Buschke
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York City, New York, USA
| | - Jiří Nepožitek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pavla Peřinová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Simona Dostálová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Veronika Ibarburu Lorenzo Y Losada
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karel Šonka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petr Dušek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ondrej Bezdicek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Bock MA, Tanner CM. The epidemiology of cognitive function in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:3-37. [PMID: 35248199 DOI: 10.1016/bs.pbr.2022.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epidemiology is the study of the distribution of disease in human populations, which is important in evaluating burden of illness, identifying modifiable risk factors, and planning for current and projected needs of the health care system. Parkinson's disease (PD) is the second most common serious neurodegenerative illness and is expected to further increase in prevalence. Cognitive changes are increasingly viewed as an integral non-motor feature in PD, emerging even in the prodromal phase of the disease. The prevalence of PD-MCI ranges from 20% to 40% depending on the population studied. The incidence of PD-dementia increases with duration of disease, with estimates growing from 3% to 30% of individuals followed for 5 years or less to over 80% after 20 years. There are several challenges in estimating the frequency of cognitive change, including only recently standardized diagnostic criteria, variation depending on exact neuropsychological evaluations performed, and differences in population sampling. Clinical features associated with cognitive decline include older age, increased disease duration and severity, early gait dysfunction, dysautonomia, hallucinations and other neuropsychiatric features, the presence of REM behavior disorder, and posterior predominant dysfunction on neuropsychological testing. There is increasing evidence that genetic risk factors, in particular GBA and MAPT mutations, contribute to cognitive change. Possible protective factors include higher cognitive reserve and regular exercise. Important sequelae of cognitive decline in PD include higher caregiver burden, decreased functional status, and increased risk of institutionalization and mortality. Many remaining uncertainties regarding the epidemiology of cognitive change in PD require future research, with improved biomarkers and more sensitive and convenient outcome measures.
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Affiliation(s)
- Meredith A Bock
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, United States; Mental Illness Research, Education, and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States; Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States
| | - Caroline M Tanner
- Movement Disorders and Neuromodulation Center, Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, CA, United States; Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Health Care System, San Francisco, CA, United States.
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8
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Diaconu Ș, Falup-Pecurariu O, Țînț D, Falup-Pecurariu C. REM sleep behaviour disorder in Parkinson's disease (Review). Exp Ther Med 2021; 22:812. [PMID: 34131435 DOI: 10.3892/etm.2021.10244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/28/2021] [Indexed: 01/23/2023] Open
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia defined by simple or complex abnormal movements occurring in REM state, instead of the physiological muscular atonia. RBD may be idiopathic, or secondary as in the case of Parkinson's disease (PD). Several studies have confirmed that idiopathic RBD may precede with several years the onset of the specific motor characteristics of PD. The high prevalence of RBD in PD (19-70%) may be explained by several common pathophysiological pathways, mainly related to the dopaminergic cell loss. RBD is also associated with several comorbidities, including cognitive impairment, hallucinations, dysautonomia, or daytime sleepiness. The gold standard investigation for the diagnosis and assessment of RBD is video polysomnography, but in clinical practice, the use of clinical scales and questionnaires is reasonable for the screening of this complex parasomnia. Management options include ensuring a safe environment for the patient and pharmacological treatment, incuding clonazepam, melatonin or certain antiparkinsonian drugs.
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Affiliation(s)
- Ștefania Diaconu
- Faculty of Medicine, Transilvania University, 500036 Brașov, Romania
| | | | - Diana Țînț
- Faculty of Medicine, Transilvania University, 500036 Brașov, Romania.,Department of Electrophysiology and Implantable Devices, Clinicco Hospital, 500059 Brașov, Romania
| | - Cristian Falup-Pecurariu
- Faculty of Medicine, Transilvania University, 500036 Brașov, Romania.,Department of Neurology, County Emergency Clinic Hospital, 500365 Brașov, Romania
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9
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Lo C, Arora S, Ben-Shlomo Y, Barber TR, Lawton M, Klein JC, Kanavou S, Janzen A, Sittig E, Oertel WH, Grosset DG, Hu MT. Olfactory Testing in Parkinson Disease and REM Behavior Disorder: A Machine Learning Approach. Neurology 2021; 96:e2016-e2027. [PMID: 33627500 DOI: 10.1212/wnl.0000000000011743] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 01/15/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We sought to identify an abbreviated test of impaired olfaction amenable for use in busy clinical environments in prodromal (isolated REM sleep behavior disorder [iRBD]) and manifest Parkinson disease (PD). METHODS Eight hundred ninety individuals with PD and 313 controls in the Discovery cohort study underwent Sniffin' Stick odor identification assessment. Random forests were initially trained to distinguish individuals with poor (functional anosmia/hyposmia) and good (normosmia/super-smeller) smell ability using all 16 Sniffin' Sticks. Models were retrained using the top 3 sticks ranked by order of predictor importance. One randomly selected 3-stick model was tested in a second independent PD dataset (n = 452) and in 2 iRBD datasets (Discovery n = 241, Marburg n = 37) before being compared to previously described abbreviated Sniffin' Stick combinations. RESULTS In differentiating poor from good smell ability, the overall area under the curve (AUC) value associated with the top 3 sticks (anise/licorice/banana) was 0.95 in the Development dataset (sensitivity 90%, specificity 92%, positive predictive value 92%, negative predictive value 90%). Internal and external validation confirmed AUCs ≥0.90. The combination of the 3-stick model determined poor smell, and an RBD screening questionnaire score of ≥5 separated those with iRBD from controls with a sensitivity, specificity, positive predictive value, and negative predictive value of 65%, 100%, 100%, and 30%. CONCLUSIONS Our 3-Sniffin'-Stick model holds potential utility as a brief screening test in the stratification of individuals with PD and iRBD according to olfactory dysfunction. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that a 3-Sniffin'-Stick model distinguishes individuals with poor and good smell ability and can be used to screen for individuals with iRBD.
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Affiliation(s)
- Christine Lo
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK.
| | - Siddharth Arora
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Yoav Ben-Shlomo
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Thomas R Barber
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Michael Lawton
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Johannes C Klein
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Sofia Kanavou
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Annette Janzen
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Elisabeth Sittig
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Wolfgang H Oertel
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Donald G Grosset
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Michele T Hu
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
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10
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Cognitive and Neuropsychiatric Profiles in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinson's Disease. J Pers Med 2021; 11:jpm11010051. [PMID: 33467021 PMCID: PMC7830588 DOI: 10.3390/jpm11010051] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 11/17/2022] Open
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a risk factor for developing Parkinson’s disease (PD) and may represent its prodromal state. We compared neuropsychological and neuropsychiatric phenotypes of idiopathic (i) RBD, PD and healthy comparators (HC) in order to identify iRBD specific characteristics. Thirty-eight patients with iRBD, 38 PD patients with RBD (PD + RBD), 38 PD patients without RBD (PD-RBD) and 38 HC underwent a comprehensive neurological, neuropsychological and neuropsychiatric evaluation. iRBD, PD + RBD and PD-RBD performed worse than HC in short-term verbal memory, praxia, language and executive functions. iRBD had higher levels of anxiety, depression, apathy and alexithymia than HC. iRBD had higher levels of apathy than PD + RBD. Both PD groups had higher levels of anxiety and depression than HC. Surprisingly, iRBD performed better than all groups in long-term verbal memory. Patients diagnosed with iRBD are characterized by poor global cognitive performance, but better long-term memory and higher levels of depression, anxiety, alexithymia and apathy. Alexithymia and apathy in patients diagnosed with iRBD may be the expression of precocious derangement of emotional regulation, subsequently observed also in PD. Cognitive and neuropsychiatric symptoms of iRBD are early clinical manifestations of widespread neurodegeneration.
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11
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Grogan JP, Fallon SJ, Zokaei N, Husain M, Coulthard EJ, Manohar SG. A new toolbox to distinguish the sources of spatial memory error. J Vis 2020; 20:6. [PMID: 33289797 PMCID: PMC7726590 DOI: 10.1167/jov.20.13.6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/23/2020] [Indexed: 12/01/2022] Open
Abstract
Studying the sources of errors in memory recall has proven invaluable for understanding the mechanisms of working memory (WM). While one-dimensional memory features (e.g., color, orientation) can be analyzed using existing mixture modeling toolboxes to separate the influence of imprecision, guessing, and misbinding (the tendency to confuse features that belong to different memoranda), such toolboxes are not currently available for two-dimensional spatial WM tasks. Here we present a method to isolate sources of spatial error in tasks where participants have to report the spatial location of an item in memory, using two-dimensional mixture models. The method recovers simulated parameters well and is robust to the influence of response distributions and biases, as well as number of nontargets and trials. To demonstrate the model, we fit data from a complex spatial WM task and show the recovered parameters correspond well with previous spatial WM findings and with recovered parameters on a one-dimensional analogue of this task, suggesting convergent validity for this two-dimensional modeling approach. Because the extra dimension allows greater separation of memoranda and responses, spatial tasks turn out to be much better for separating misbinding from imprecision and guessing than one-dimensional tasks. Code for these models is freely available in the MemToolbox2D package and is integrated to work with the commonly used MATLAB package MemToolbox.
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Affiliation(s)
- John P Grogan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sean J Fallon
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Nahid Zokaei
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Centre for Human Brain Activity, University of Oxford, Oxford, UK
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Elizabeth J Coulthard
- Translational Health Sciences, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Sanjay G Manohar
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Centre for Human Brain Activity, University of Oxford, Oxford, UK
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12
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Zokaei N, Sillence A, Kienast A, Drew D, Plant O, Slavkova E, Manohar SG, Husain M. Different patterns of short-term memory deficit in Alzheimer's disease, Parkinson's disease and subjective cognitive impairment. Cortex 2020; 132:41-50. [PMID: 32919108 PMCID: PMC7651994 DOI: 10.1016/j.cortex.2020.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/25/2020] [Accepted: 06/23/2020] [Indexed: 01/06/2023]
Abstract
It has recently been proposed that short-term memory (STM) binding deficits might be an important feature of Alzheimer's disease (AD), providing a potential avenue for earlier detection of this disorder. By contrast, work in Parkinson's disease (PD), using different tasks, has suggested that the STM impairment in this condition is characterised by increased random guessing, possibly due to fluctuating attention. In the present study, to establish whether a misbinding impairment is present in sporadic late-onset AD (LOAD) and increased guessing is a feature of PD, we compared the performance of these patient groups to two control populations: healthy age-matched controls and individuals with subjective cognitive impairment (SCI) with comparable recruitment history as patients. All participants performed a sensitive task of STM that required high resolution retention of object-location bindings. This paradigm also enabled us to explore the underlying sources of error contributing to impaired STM in patients with LOAD and PD using computational modelling of response error. Patients with LOAD performed significantly worse than other groups on this task. Importantly their impaired memory was associated with increased misbinding errors. This was in contrast to patients with PD who made significantly more guessing responses. These findings therefore provide additional support for the presence of two doubly dissociable signatures of STM deficit in AD and PD, with binding impairment in AD and increased random guessing characterising the STM deficit in PD. The task used to measure memory precision here provides an easy-to-administer assessment of STM that is sensitive to the different types of deficit in AD and PD and hence has the potential to inform clinical practice.
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Affiliation(s)
- Nahid Zokaei
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK; Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK.
| | - Annie Sillence
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK
| | - Annika Kienast
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK
| | - Daniel Drew
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK; Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, Oxford, UK
| | - Olivia Plant
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK
| | - Ellie Slavkova
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK
| | - Sanjay G Manohar
- Oxford NIHR Biomedical Research Centre, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK; Oxford NIHR Biomedical Research Centre, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
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13
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Schurgin MW, Wixted JT, Brady TF. Psychophysical scaling reveals a unified theory of visual memory strength. Nat Hum Behav 2020; 4:1156-1172. [DOI: 10.1038/s41562-020-00938-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/28/2020] [Indexed: 11/09/2022]
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14
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Jendryczko D, Berkemeyer L, Holling H. Introducing a Computerized Figural Memory Test Based on Automatic Item Generation: An Analysis With the Rasch Poisson Counts Model. Front Psychol 2020; 11:945. [PMID: 32587542 PMCID: PMC7298330 DOI: 10.3389/fpsyg.2020.00945] [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: 02/19/2020] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
An automatic item generator for figural memory test items called figumem was developed. It is available in R. A cognitive model allowed the generation of hypothetically parallel items within three difficulty levels determined by visual information load. In a pilot study, participants solved three items for each level of visual load. Within an item response theory approach, the Rasch Poisson counts model and modifications of it were fitted to the data. Results showed overall satisfying fit. Visual information load explained most of the variance in item difficulty. Differences in difficulty between items of the same family were comparatively low, displaying the utility of the item generator for the creation of parallel test forms. Implications, limitations, and suggestions for the use and extensions of figumem are discussed.
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Affiliation(s)
- David Jendryczko
- Institute for Psychology, Universität Konstanz, Konstanz, Germany
- Institute for Psychology, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Laura Berkemeyer
- Institute for Psychology, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Heinz Holling
- Institute for Psychology, Westfälische Wilhelms-Universität Münster, Münster, Germany
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15
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Giehl K, Ophey A, Reker P, Rehberg S, Hammes J, Barbe MT, Zokaei N, Eggers C, Husain M, Kalbe E, van Eimeren T. Effects of Home-Based Working Memory Training on Visuo-Spatial Working Memory in Parkinson's Disease: A Randomized Controlled Trial. J Cent Nerv Syst Dis 2020; 12:1179573519899469. [PMID: 32002011 PMCID: PMC6966247 DOI: 10.1177/1179573519899469] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/08/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cognitive impairment is a very frequent and severe nonmotor symptom of Parkinson's disease (PD). Early intervention in this at-risk group for cognitive decline may be crucial for long-term preservation of cognitive functions. Computerized working memory training (WMT) has been proven beneficial in non-PD patient populations, but such evidence is still needed for patients with PD. OBJECTIVE This study aimed to evaluate the effect of WMT on visuo-spatial working memory (WM) in cognitively unimpaired patients with PD. METHODS A single-blind randomized controlled trial encompassing 76 patients with PD but no cognitive impairment according to level II diagnostic criteria was conducted. Thirty-seven patients engaged in home-based adaptive WMT 5 times per week for a period of 5 weeks, whereas the remaining patients were in the waiting list arm of the study (control group [CG]). Working memory performance was evaluated using a computerized task before and after intervention and at 14-week follow-up, allowing to quantify the precision of WM on a continuous scale, ie, to test not only if an item was remembered but also how well the location of this item was retained. RESULTS Coincidently, the WMT group showed slightly worse WM performance compared with the CG at baseline, which was ameliorated after WMT. This training-induced effect remained stable until follow-up. CONCLUSION Patients showing relatively low WM performance, despite not formally diagnosable as Parkinson's disease with mild cognitive impairment (PD-MCI), seem to benefit from home-based WMT. Thus, WMT could potentially be implemented in future trials as a time- and cost-efficient route to counteract subtle cognitive changes in early disease stages. TRIAL REGISTRATION German Clinical Trial Register (drks.de, DRKS00009379).
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Affiliation(s)
- Kathrin Giehl
- Multimodal Neuroimaging Group,
Department of Nuclear Medicine, University Hospital of Cologne, Faculty of Medicine,
University of Cologne, Cologne, Germany
| | - Anja Ophey
- Department of Medical Psychology,
Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and
Intervention (CeNDI), University Hospital of Cologne, Faculty of Medicine,
University of Cologne, Cologne, Germany
| | - Paul Reker
- Department of Neurology, University
Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne,
Germany
| | - Sarah Rehberg
- Department of Medical Psychology,
Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and
Intervention (CeNDI), University Hospital of Cologne, Faculty of Medicine,
University of Cologne, Cologne, Germany
| | - Jochen Hammes
- Multimodal Neuroimaging Group,
Department of Nuclear Medicine, University Hospital of Cologne, Faculty of Medicine,
University of Cologne, Cologne, Germany
| | - Michael T Barbe
- Department of Neurology, University
Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne,
Germany
| | - Nahid Zokaei
- Oxford Centre for Human Brain Activity,
Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University
of Oxford, Oxford, UK
| | - Carsten Eggers
- Department of Neurology, University
Hospital of Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg,
Germany
- Center for Mind, Brain and Behavior,
Philipps-University of Marburg and Justus Liebig University Giessen, Marburg,
Germany
| | - Masud Husain
- Nuffield Department of Clinical
Neurosciences, University of Oxford, Oxford, UK
- Department of Experimental Psychology,
University of Oxford, Oxford, UK
| | - Elke Kalbe
- Department of Medical Psychology,
Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and
Intervention (CeNDI), University Hospital of Cologne, Faculty of Medicine,
University of Cologne, Cologne, Germany
| | - Thilo van Eimeren
- Multimodal Neuroimaging Group,
Department of Nuclear Medicine, University Hospital of Cologne, Faculty of Medicine,
University of Cologne, Cologne, Germany
- Department of Neurology, University
Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne,
Germany
- German Center for Neurodegenerative
Diseases (DZNE), Bonn, Germany
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16
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Ferini-Strambi L, Fasiello E, Sforza M, Salsone M, Galbiati A. Neuropsychological, electrophysiological, and neuroimaging biomarkers for REM behavior disorder. Expert Rev Neurother 2019; 19:1069-1087. [PMID: 31277555 DOI: 10.1080/14737175.2019.1640603] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction: Rapid eye movement (REM) sleep behavior disorder (RBD) is a REM sleep parasomnia characterized by dream enacting behaviors allowed by the loss of physiological atonia during REM sleep. This disorder is recognized as a prodromal stage of neurodegenerative disease, in particular Parkinson's Disease (PD) and Dementia with Lewy Bodies (DLB). Therefore, a timely identification of biomarkers able to predict an early conversion into neurodegeneration is of utmost importance. Areas covered: In this review, the authors provide updated evidence regarding the presence of neuropsychological, electrophysiological and neuroimaging markers in isolated RBD (iRBD) patients when the neurodegeneration is yet to come. Expert opinion: Cognitive profile of iRBD patients is characterized by the presence of impairment in visuospatial abilities and executive function that is observed in α-synucleinopathies. However, longitudinal studies showed that impaired executive functions, rather than visuospatial abilities, augmented conversion risk. Cortical slowdown during wake and REM sleep suggest the presence of an ongoing neurodegenerative process paralleled by cognitive decline. Neuroimaging findings showed that impairment nigrostriatal dopaminergic system might be a good marker to identify those patients at higher risk of short-term conversion. Although a growing body of evidence the identification of biomarkers still represents a critical issue in iRBD.
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Affiliation(s)
- Luigi Ferini-Strambi
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute , Milan , Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University , Milan , Italy
| | - Elisabetta Fasiello
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute , Milan , Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University , Milan , Italy
| | - Marco Sforza
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute , Milan , Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University , Milan , Italy
| | - Maria Salsone
- Institute of Molecular Bioimaging and Physiology, National Research Council , Catanzaro , Italy
| | - Andrea Galbiati
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute , Milan , Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University , Milan , Italy
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17
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Zokaei N, Nour MM, Sillence A, Drew D, Adcock J, Stacey R, Voets N, Sen A, Husain M. Binding deficits in visual short-term memory in patients with temporal lobe lobectomy. Hippocampus 2019; 29:63-67. [PMID: 30069971 PMCID: PMC6492115 DOI: 10.1002/hipo.22998] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 04/27/2018] [Accepted: 05/26/2018] [Indexed: 12/31/2022]
Abstract
Classical views of the medial temporal lobe (MTL) have established that it plays a crucial role in long-term memory (LTM). Here we demonstrate, in a sample of patients who have undergone anterior temporal lobectomy for the treatment of pharmacoresistant epilepsy, that the MTL additionally plays a specific, causal role in short-term memory (STM). Patients (n=22) and age-matched healthy control participants (n=26) performed a STM task with a sensitive continuous report measure. This paradigm allowed us to examine recall memory for object identity, location and object-location binding, independently on a trial-by-trial basis. Our findings point to a specific involvement of MTL in object-location binding, but, crucially, not retention of either object identity or location. Therefore the MTL appears to perform a specific computation: binding disparate features that belong to a memory. These results echo findings from previous studies, which have identified a role for the MTL in relational binding for LTM, and support the proposal that MTL regions perform such a function for both STM and LTM, independent of the retention duration. Furthermore, these findings and the methodology employed here may provide a simple, sensitive and clinically valuable means to test memory dysfunuction in MTL disorders.
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Affiliation(s)
- Nahid Zokaei
- Department of Psychiatry, Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Matthew M. Nour
- Institute of Psychiatry, Psychology, and NeuroscienceKings College LondonLondonUK
| | - Annie Sillence
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Daniel Drew
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Nuffield Department of Clinical Neurosciences, Oxford NIHR Biomedical Research CentreUniversity of OxfordOxfordUK
| | - Jane Adcock
- Nuffield Department of Clinical Neurosciences, Oxford NIHR Biomedical Research CentreUniversity of OxfordOxfordUK
| | - Richard Stacey
- Oxford University HospitalsNHS Foundation Trust, University of OxfordOxfordUK
| | - Natalie Voets
- Nuffield Department of Clinical Neurosciences, Oxford NIHR Biomedical Research CentreUniversity of OxfordOxfordUK
| | - Arjune Sen
- Nuffield Department of Clinical Neurosciences, Oxford NIHR Biomedical Research CentreUniversity of OxfordOxfordUK
- Oxford Epilepsy Research GroupOxford University Hospitals, NHS Foundation Trust, University of OxfordOxfordUK
| | - Masud Husain
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Nuffield Department of Clinical Neurosciences, Oxford NIHR Biomedical Research CentreUniversity of OxfordOxfordUK
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18
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Zokaei N, Čepukaitytė G, Board AG, Mackay CE, Husain M, Nobre AC. Dissociable effects of the apolipoprotein-E (APOE) gene on short- and long-term memories. Neurobiol Aging 2019; 73:115-122. [PMID: 30342272 PMCID: PMC6261846 DOI: 10.1016/j.neurobiolaging.2018.09.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/22/2018] [Accepted: 09/15/2018] [Indexed: 12/27/2022]
Abstract
Short- and long-term memory performance as a function of apolipoprotein-E (APOE) genotype was examined in older, healthy individuals using sensitive and comparable tasks to provide a more detailed description of influences of the ε4 allele (highest genetic risk factor for Alzheimer's disease) on memory. Older heterozygous and homozygous ε4 carriers and noncarriers performed 2 tasks of memory. Both tasks allowed us to measure memory for item identity and locations, using a sensitive, continuous measure of report. Long-term memory for object locations was impaired in ε4/ε4 carriers, whereas, paradoxically, this group demonstrated superior short-term memory for locations. The dissociable effects of the gene on short- and long-term memory suggest that the effect of genotype on these two types of memories, and their neural underpinnings, might not be co-extensive. Whereas the long-term memory impairment might be linked to preclinical Alzheimer's disease, the short-term memory advantage may reflect an independent, phenotypical effect of this allele on cognition.
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Affiliation(s)
- Nahid Zokaei
- Department of Psychiatry, Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK; Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - Giedrė Čepukaitytė
- Department of Psychiatry, Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK; Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Alexander G Board
- Department of Psychiatry, Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK; Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Clare E Mackay
- Department of Psychiatry, Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anna Christina Nobre
- Department of Psychiatry, Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK; Department of Experimental Psychology, University of Oxford, Oxford, UK
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19
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Abstract
Working memory impairments are frequently observed in patients with Alzheimer's disease (AD) and Parkinson's disease (PD). Recent research suggests that the mechanisms underlying these deficits might be dissociable using sensitive tasks, specifically those that rely on the reproduction of the exact quality of features held in memory.In patients with AD, working memory impairments are mainly due to an increase in misbinding errors. They arise when patients misremember which features (e.g., color, orientation, shape, and location) belong to different objects held in memory. Hence, they erroneously report features that belong to items in memory other than the one they are probed on. This misbinding of features that belong to different objects in memory can be considered a form of interference between stored items. Such binding errors are evident even in presymptomatic individuals with familial AD (due to gene mutations) who do not have AD yet. Overall, these findings are in line with the role of the medial temporal lobes, and specifically the hippocampus, in retention of feature bindings, regardless of retention duration, i.e., in both short- or long-term memory.Patients with PD, on the other hand, do not show increased misbinding. Their working memory deficits are associated with making more random errors or guesses. These random responses are not modulated by manipulations of their dopaminergic medication and hence may reflect involvement of non-dopaminergic neurotransmitters in this deficit. In addition, patients with PD demonstrate impairments in gating of information into relevant vs. irrelevant items in memory, a cognitive operation that is modulated by dopaminergic manipulation in line with a frontal executive effect of this neurotransmitter. Thus, although AD and PD are both associated with working memory impairments, these surface manifestations appear to be underpinned by very different mechanisms.
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Affiliation(s)
- Nahid Zokaei
- Oxford Centre for Human Brain Activity, University of Oxford, Oxford, UK.
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
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20
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Smith AM, Depp C, Ryan BJ, Johnston GI, Alegre-Abarrategui J, Evetts S, Rolinski M, Baig F, Ruffmann C, Simon AK, Hu MTM, Wade-Martins R. Mitochondrial dysfunction and increased glycolysis in prodromal and early Parkinson's blood cells. Mov Disord 2018; 33:1580-1590. [PMID: 30294923 PMCID: PMC6221131 DOI: 10.1002/mds.104] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/18/2018] [Accepted: 05/24/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Although primarily a neurodegenerative process, there is increasing awareness of peripheral disease mechanisms in Parkinson's disease. To investigate disease processes in accessible patient cells, we studied peripheral blood mononuclear cells in recently diagnosed PD patients and rapid eye movement‐sleep behavior disorder patients who have a greatly increased risk of developing PD. We hypothesized that peripheral blood mononuclear cells may recapitulate cellular pathology found in the PD brain and investigated these cells for mitochondrial dysfunction and oxidative stress. Methods: Peripheral blood mononuclear cells were isolated and studied from PD patients, rapid eye movement‐sleep behavior disorder patients and age‐ and sex‐matched control individuals from the well‐characterized Oxford Discovery cohort. All participants underwent thorough clinical assessment. Results: Initial characterization showed that PD patients had elevated levels of CD14 + monocytes and monocytes expressing C‐C motif chemokine receptor 2. Mitochondrial dysfunction and oxidative stress were increased in PD patient peripheral blood mononuclear cells, with elevated levels of mitochondrial reactive oxygen species specifically in patient monocytes. This was combined with reduced levels of the antioxidant superoxide dismutase in blood cells from PD patients and, importantly, also in rapid eye movement‐sleep behavior disorder patients. This mitochondrial dysfunction was associated with a concomitant increase in glycolysis in both PD and rapid eye movement‐sleep behavior disorder patient blood cells independent of glucose uptake or monocyte activation. Conclusions: This work demonstrates functional bioenergetic deficits in PD and rapid eye movement‐sleep behavior disorder patient blood cells during the early stages of human disease. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Amy M Smith
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Constanze Depp
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Brent J Ryan
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | | | - Javier Alegre-Abarrategui
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Samuel Evetts
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Michal Rolinski
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Fahd Baig
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Claudio Ruffmann
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anna Katharina Simon
- Translational Immunology Laboratory, NIHR BRC, University of Oxford, Oxford, UK.,Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Michele T M Hu
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Richard Wade-Martins
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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21
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Klein JC, Rolinski M, Griffanti L, Szewczyk-Krolikowski K, Baig F, Ruffmann C, Groves AR, Menke RAL, Hu MT, Mackay C. Cortical structural involvement and cognitive dysfunction in early Parkinson's disease. NMR IN BIOMEDICINE 2018; 31:e3900. [PMID: 29436039 DOI: 10.1002/nbm.3900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/13/2017] [Accepted: 01/03/2018] [Indexed: 06/08/2023]
Abstract
Magnetic resonance imaging (MRI) studies in early Parkinson's disease (PD) have shown promise in the detection of disease-related brain changes in the white and deep grey matter. We set out to establish whether intrinsic cortical involvement in early PD can be detected with quantitative MRI. We collected a rich, multi-modal dataset, including diffusion MRI, T1 relaxometry and cortical morphometry, in 20 patients with early PD (disease duration, 1.9 ± 0.97 years, Hoehn & Yahr 1-2) and in 19 matched controls. The cortex was reconstructed using FreeSurfer. Data analysis employed linked independent component analysis (ICA), a novel data-driven technique that allows for data fusion and extraction of multi-modal components before further analysis. For comparison, we performed standard uni-modal analysis with a general linear model (GLM). Linked ICA detected multi-modal cortical changes in early PD (p = 0.015). These comprised fractional anisotropy reduction in dorsolateral prefrontal, cingulate and premotor cortex and the superior parietal lobule, mean diffusivity increase in the mesolimbic, somatosensory and superior parietal cortex, sparse diffusivity decrease in lateral parietal and right prefrontal cortex, and sparse changes to the cortex area. In PD, the amount of cortical dysintegrity correlated with diminished cognitive performance. Importantly, uni-modal analysis detected no significant group difference on any imaging modality. We detected microstructural cortical pathology in early PD using a data-driven, multi-modal approach. This pathology is correlated with diminished cognitive performance. Our results indicate that early degenerative processes leave an MRI signature in the cortex of patients with early PD. The cortical imaging findings are behaviourally meaningful and provide a link between cognitive status and microstructural cortical pathology in patients with early PD.
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Affiliation(s)
- J C Klein
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging (WIN), FMRIB Centre, University of Oxford, Oxford, UK
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - M Rolinski
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - L Griffanti
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging (WIN), FMRIB Centre, University of Oxford, Oxford, UK
| | - K Szewczyk-Krolikowski
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
| | - F Baig
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - C Ruffmann
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - A R Groves
- Wellcome Centre for Integrative Neuroimaging (WIN), FMRIB Centre, University of Oxford, Oxford, UK
| | - R A L Menke
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Wellcome Centre for Integrative Neuroimaging (WIN), FMRIB Centre, University of Oxford, Oxford, UK
| | - M T Hu
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - C Mackay
- Oxford Parkinson's Disease Centre, Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
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22
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St Louis EK, Boeve AR, Boeve BF. REM Sleep Behavior Disorder in Parkinson's Disease and Other Synucleinopathies. Mov Disord 2018; 32:645-658. [PMID: 28513079 DOI: 10.1002/mds.27018] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 12/15/2022] Open
Abstract
Rapid eye movement sleep behavior disorder is characterized by dream enactment and complex motor behaviors during rapid eye movement sleep and rapid eye movement sleep atonia loss (rapid eye movement sleep without atonia) during polysomnography. Rapid eye movement sleep behavior disorder may be idiopathic or symptomatic and in both settings is highly associated with synucleinopathy neurodegeneration, especially Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure. Rapid eye movement sleep behavior disorder frequently manifests years to decades prior to overt motor, cognitive, or autonomic impairments as the presenting manifestation of synucleinopathy, along with other subtler prodromal "soft" signs of hyposmia, constipation, and orthostatic hypotension. Between 35% and 91.9% of patients initially diagnosed with idiopathic rapid eye movement sleep behavior disorder at a sleep center later develop a defined neurodegenerative disease. Less is known about the long-term prognosis of community-dwelling younger patients, especially women, and rapid eye movement sleep behavior disorder associated with antidepressant medications. Patients with rapid eye movement sleep behavior disorder are frequently prone to sleep-related injuries and should be treated to prevent injury with either melatonin 3-12 mg or clonazepam 0.5-2.0 mg to limit injury potential. Further evidence-based studies about rapid eye movement sleep behavior disorder are greatly needed, both to enable accurate prognostic prediction of end synucleinopathy phenotypes for individual patients and to support the application of symptomatic and neuroprotective therapies. Rapid eye movement sleep behavior disorder as a prodromal synucleinopathy represents a defined time point at which neuroprotective therapies could potentially be applied for the prevention of Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Erik K St Louis
- Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Angelica R Boeve
- Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Bradley F Boeve
- Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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23
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Abstract
So-called idiopathic rapid eye movement (REM) sleep behaviour disorder (RBD), formerly seen as a rare parasomnia, is now recognized as the prodromal stage of an α-synucleinopathy. Given the very high risk that patients with idiopathic RBD have of developing α-synucleinopathies, such as Parkinson disease (PD), PD dementia, dementia with Lewy bodies or multiple system atrophy, and the outstandingly high specificity and very long interval between the onset of idiopathic RBD and the clinical manifestations of α-synucleinopathies, the prodromal phase of this disorder represents a unique opportunity for potentially disease-modifying intervention. This Review provides an update on classic and novel biomarkers of α-synuclein-related neurodegeneration in patients with idiopathic RBD, focusing on advances in imaging and neurophysiological, cognitive, autonomic, tissue-specific and other biomarkers. We discuss the strengths, potential weaknesses and suitability of these biomarkers for identifying RBD and neurodegeneration, with an emphasis on predicting progression to overt α-synucleinopathy. The role of video polysomnography in providing quantifiable and potentially treatment-responsive biomarkers of neurodegeneration is highlighted. In light of all these advances, and the now understood role of idiopathic RBD as an early manifestation of α-synuclein disease, we call for idiopathic RBD to be reconceptualized as isolated RBD.
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24
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St Louis EK, Boeve BF. REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions. Mayo Clin Proc 2017; 92:1723-1736. [PMID: 29101940 PMCID: PMC6095693 DOI: 10.1016/j.mayocp.2017.09.007] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 09/12/2017] [Accepted: 09/21/2017] [Indexed: 12/25/2022]
Abstract
Rapid eye movement sleep behavior disorder (RBD) is diagnosed by a clinical history of dream enactment accompanied by polysomnographic rapid eye movement sleep atonia loss (rapid eye movement sleep without atonia). Rapid eye movement sleep behavior disorder is strongly associated with neurodegenerative disease, especially synucleinopathies such as Parkinson disease, dementia with Lewy bodies, and multiple system atrophy. A history of RBD may begin several years to decades before onset of any clear daytime symptoms of motor, cognitive, or autonomic impairments, suggesting that RBD is the presenting manifestation of a neurodegenerative process. Evidence that RBD is a synlucleinopathy includes the frequent presence of subtle prodromal neurodegenerative abnormalities including hyposmia, constipation, and orthostatic hypotension, as well as abnormalities on various neuroimaging, neurophysiological, and autonomic tests. Up to 90.9% of patients with idiopathic RBD ultimately develop a defined neurodegenerative disease over longitudinal follow-up, although the prognosis for younger patients and antidepressant-associated RBD is less clear. Patients with RBD should be treated with either melatonin 3 to 12 mg or clonazepam 0.5 to 2.0 mg to reduce injury potential. Prospective outcome and treatment studies of RBD are necessary to enable accurate prognosis and better evidence for symptomatic therapy and future neuroprotective strategies.
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Affiliation(s)
- Erik K St Louis
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN.
| | - Bradley F Boeve
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
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25
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Reduced P300 amplitude during a visuospatial attention task in idiopathic rapid eye movement sleep behavior disorder. Sleep Med 2017; 38:78-84. [DOI: 10.1016/j.sleep.2017.06.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/23/2017] [Accepted: 06/26/2017] [Indexed: 11/24/2022]
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26
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Chwiszczuk L, Breitve MH, Brønnick K, Gjerstad MD, Hynninen M, Aarsland D, Rongve A. REM Sleep Behavior Disorder Is Not Associated with a More Rapid Cognitive Decline in Mild Dementia. Front Neurol 2017; 8:375. [PMID: 28824532 PMCID: PMC5545761 DOI: 10.3389/fneur.2017.00375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022] Open
Abstract
Objectives REM sleep behavior disorder (RBD) is associated with cognitive dysfunctions and is a risk factor for development of mild cognitive impairment and dementia. However, it is unknown whether RBD is associated with faster cognitive decline in already established dementia. The main goal of this study was to determine if patients with mild dementia with and without RBD differ in progression rate and in specific neuropsychological measures over 4-year follow-up. Methods This longitudinal, prospective study based on data from the DemVest study compares neuropsychological measures in a mild dementia cohort. A diagnosis of probable RBD (pRBD) was made based on the Mayo Sleep Questionnaire. Neuropsychological domains were assessed by Mini Mental State Examination, total score and figure copying, California Verbal Learning Test-II, Visual Object and Space Perception Cube and Silhouettes, Boston Naming Test, Stroop test, Verbal Category Fluency, Trail Making Test A and B. Results Among the 246 subjects, 47 (19.1%) had pRBD at the baseline, and pRBD group was younger and with male predominance. During 4-year follow-up, we did not observe any significant differences in the rate of decline in neuropsychological measures. Patients with pRBD performed generally poorer in visuoconstructional, visuoperceptual, and executive/attention tests in comparison to RBD negative. Conclusion We did not find any significant differences in progression rate of neurocognitive outcomes between dementia patients with and without RBD.
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Affiliation(s)
- Luiza Chwiszczuk
- Department of Old Age Psychiatry, Helse Fonna HF, Haugesund Hospital, Haugesund, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Research and Innovation, Helse Fonna HF, Haugesund Hospital, Haugesund, Norway
| | - Monica Haraldseid Breitve
- Department of Old Age Psychiatry, Helse Fonna HF, Haugesund Hospital, Haugesund, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Research and Innovation, Helse Fonna HF, Haugesund Hospital, Haugesund, Norway
| | - Kolbjørn Brønnick
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Michaela D Gjerstad
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Minna Hynninen
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,NKS Olaviken, Gerontopsychiatric Hospital, Bergen, Norway
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom.,Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Arvid Rongve
- Department of Old Age Psychiatry, Helse Fonna HF, Haugesund Hospital, Haugesund, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Research and Innovation, Helse Fonna HF, Haugesund Hospital, Haugesund, Norway
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27
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Tekriwal A, Kern DS, Tsai J, Ince NF, Wu J, Thompson JA, Abosch A. REM sleep behaviour disorder: prodromal and mechanistic insights for Parkinson's disease. J Neurol Neurosurg Psychiatry 2017; 88:445-451. [PMID: 27965397 DOI: 10.1136/jnnp-2016-314471] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 11/04/2022]
Abstract
Rapid eye movement (REM) sleep behaviour disorder (RBD) is characterised by complex motor enactment of dreams and is a potential prodromal marker of Parkinson's disease (PD). Of note, patients with PD observed during RBD episodes exhibit improved motor function, relative to baseline states during wake periods. Here, we review recent epidemiological and mechanistic findings supporting the prodromal value of RBD for PD, incorporating clinical and electrophysiological studies. Explanations for the improved motor function during RBD episodes are evaluated in light of recent publications. In addition, we present preliminary findings describing changes in the activity of the basal ganglia across the sleep-wake cycle that contribute to our understanding of RBD.
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Affiliation(s)
- Anand Tekriwal
- Department of Neurosurgery, University of Colorado-Anschutz Medical Center, Denver, Colorado, USA
| | - Drew S Kern
- Department of Neurology, University of Colorado-Anschutz Medical Center, Denver, Colorado, USA
| | - Jean Tsai
- Department of Neurology, University of Colorado-Anschutz Medical Center, Denver, Colorado, USA
| | - Nuri F Ince
- Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Jianping Wu
- Neuromodulation Global Research, Medtronic, Minneapolis, Minnesota, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado-Anschutz Medical Center, Denver, Colorado, USA
| | - Aviva Abosch
- Department of Neurosurgery, University of Colorado-Anschutz Medical Center, Denver, Colorado, USA
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28
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Husain M. Alzheimer's disease: time to focus on the brain, not just molecules. Brain 2017; 140:251-253. [DOI: 10.1093/brain/aww353] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 01/01/2023] Open
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29
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Arnaldi D, Antelmi E, St Louis EK, Postuma RB, Arnulf I. Idiopathic REM sleep behavior disorder and neurodegenerative risk: To tell or not to tell to the patient? How to minimize the risk? Sleep Med Rev 2016; 36:82-95. [PMID: 28082168 DOI: 10.1016/j.smrv.2016.11.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 10/23/2016] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
Abstract
Most people with idiopathic REM sleep behavior disorder (iRBD) have an underlying synucleinopathy, mainly Parkinson's disease (PD) or dementia with Lewy bodies, with median conversion time of 4-9 y from iRBD diagnosis and of 11-16 y from symptom onset. Subtle signs and imaging tests indicate concomitant neurodegeneration in widespread brain areas. Risk factor studies suggest that iRBD patients may have prior head injury, occupational farming, pesticide exposure, low education level and possibly more frequent family history of dream-enactment behavior (but not of PD), plus unexpected risk factors (smoking, ischemic heart disease and inhaled corticosteroid use). Unlike PD, caffeine and smoking appear not to have a protective role. Prior depression and antidepressant use may be early neurodegenerative signs rather than exclusively causative factors. Age, hyposmia, impaired color vision, abnormal dopaminergic imaging, mild cognitive impairment and possibly sleepiness, may identify patients at greater risk of more rapid conversion. The consensus is to generally disclose the neurodegenerative risk to patients (with the caveat that phenoconversion and its temporal course remain uncertain in individuals without "soft neurodegenerative signs" and those under 50 y of age), to suggest a healthy lifestyle and to take part in prospective cohort studies in anticipation of eventual neuroprotective trials.
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Affiliation(s)
- Dario Arnaldi
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Italy
| | - Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Italy
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, Departments of Neurology and Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Ronald B Postuma
- Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada
| | - Isabelle Arnulf
- Sleep Disorder Unit, Pitie-Salpetriere Hospital, APHP, Pierre and Marie Curie University, Paris, France.
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30
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Fairfoul G, McGuire LI, Pal S, Ironside JW, Neumann J, Christie S, Joachim C, Esiri M, Evetts SG, Rolinski M, Baig F, Ruffmann C, Wade‐Martins R, Hu MTM, Parkkinen L, Green AJE. Alpha-synuclein RT-QuIC in the CSF of patients with alpha-synucleinopathies. Ann Clin Transl Neurol 2016; 3:812-818. [PMID: 27752516 PMCID: PMC5048391 DOI: 10.1002/acn3.338] [Citation(s) in RCA: 368] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 11/18/2022] Open
Abstract
We have developed a novel real-time quaking-induced conversion RT-QuIC-based assay to detect alpha-synuclein aggregation in brain and cerebrospinal fluid from dementia with Lewy bodies and Parkinson's disease patients. This assay can detect alpha-synuclein aggregation in Dementia with Lewy bodies and Parkinson's disease cerebrospinal fluid with sensitivities of 92% and 95%, respectively, and with an overall specificity of 100% when compared to Alzheimer and control cerebrospinal fluid. Patients with neuropathologically confirmed tauopathies (progressive supranuclear palsy; corticobasal degeneration) gave negative results. These results suggest that RT-QuiC analysis of cerebrospinal fluid is potentially useful for the early clinical assessment of patients with alpha-synucleinopathies.
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Affiliation(s)
- Graham Fairfoul
- The National CJD Research & Surveillance UnitWestern General HospitalUniversity of EdinburghEdinburghEH4 2XUUnited Kingdom
| | - Lynne I. McGuire
- The National CJD Research & Surveillance UnitWestern General HospitalUniversity of EdinburghEdinburghEH4 2XUUnited Kingdom
| | - Suvankar Pal
- The National CJD Research & Surveillance UnitWestern General HospitalUniversity of EdinburghEdinburghEH4 2XUUnited Kingdom
- Centre for Clinical Brain SciencesWestern General HospitalEdinburghEH4 2XUUnited Kingdom
| | - James W. Ironside
- The National CJD Research & Surveillance UnitWestern General HospitalUniversity of EdinburghEdinburghEH4 2XUUnited Kingdom
| | - Juliane Neumann
- Oxford Parkinson's Disease CentreNuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalLevel 6 West WingOxfordOX3 9DUUnited Kingdom
| | - Sharon Christie
- Oxford Project to Investigate Memory and Ageing (OPTIMA)Nuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalLevel 6 West WingOxfordOX3 9DUUnited Kingdom
| | - Catherine Joachim
- Oxford Project to Investigate Memory and Ageing (OPTIMA)Nuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalLevel 6 West WingOxfordOX3 9DUUnited Kingdom
| | - Margaret Esiri
- Oxford Project to Investigate Memory and Ageing (OPTIMA)Nuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalLevel 6 West WingOxfordOX3 9DUUnited Kingdom
| | - Samuel G. Evetts
- Oxford Parkinson's Disease CentreNuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalLevel 6 West WingOxfordOX3 9DUUnited Kingdom
| | - Michal Rolinski
- Oxford Parkinson's Disease CentreNuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalLevel 6 West WingOxfordOX3 9DUUnited Kingdom
| | - Fahd Baig
- Oxford Parkinson's Disease CentreNuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalLevel 6 West WingOxfordOX3 9DUUnited Kingdom
| | - Claudio Ruffmann
- Oxford Parkinson's Disease CentreNuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalLevel 6 West WingOxfordOX3 9DUUnited Kingdom
| | - Richard Wade‐Martins
- Oxford Parkinson's Disease CentreDepartment of PhysiologyAnatomy and GeneticsUniversity of OxfordLe Gros Clark Building, South Parks RoadOxfordOX1 3QXUnited Kingdom
| | - Michele T. M. Hu
- Oxford Parkinson's Disease CentreNuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalLevel 6 West WingOxfordOX3 9DUUnited Kingdom
| | - Laura Parkkinen
- Oxford Parkinson's Disease CentreNuffield Department of Clinical NeurosciencesUniversity of OxfordJohn Radcliffe HospitalLevel 6 West WingOxfordOX3 9DUUnited Kingdom
| | - Alison J. E. Green
- The National CJD Research & Surveillance UnitWestern General HospitalUniversity of EdinburghEdinburghEH4 2XUUnited Kingdom
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Abstract
PURPOSE OF REVIEW While the distinctive motor symptoms of Parkinson disease (PD) have been described for centuries, cognitive impairment has only recently been recognized as a central feature. Studies have yielded clues to the etiology and natural history of cognitive impairment in PD, but much remains unclear and effective therapies are needed. RECENT FINDINGS Longitudinal cohort studies demonstrate that almost all patients with PD will develop dementia if they live long enough. New CSF biomarker and genetic studies suggest that it may soon be possible to forecast and track the progression of dementia in PD. Sleep and sleep disturbance appear to be intrinsically linked with PD, although the implications for individual outcomes and opportunities for intervention are unclear. Multidisciplinary treatment approaches incorporating cognitive training may help to improve outcomes. SUMMARY We review several recent advances in understanding the pathophysiology, genetics, and management of cognitive impairment in PD.
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Affiliation(s)
- Albert A Davis
- Department of Neurology (AAD, BR), Washington University School of Medicine, St. Louis, MO; and School of Public Health (BR), University of the Witwatersrand, Johannesburg, South Africa
| | - Brad Racette
- Department of Neurology (AAD, BR), Washington University School of Medicine, St. Louis, MO; and School of Public Health (BR), University of the Witwatersrand, Johannesburg, South Africa
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Parkinson disease. Sleep disorder deficits suggest signature for early Parkinson disease. Nat Rev Neurol 2015; 12:3. [PMID: 26635212 DOI: 10.1038/nrneurol.2015.232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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