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Wheeler KV, Irimia A, Braskie MN. Using Neuroimaging to Study Cerebral Amyloid Angiopathy and Its Relationship to Alzheimer's Disease. J Alzheimers Dis 2024; 97:1479-1502. [PMID: 38306032 DOI: 10.3233/jad-230553] [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] [Indexed: 02/03/2024]
Abstract
Cerebral amyloid angiopathy (CAA) is characterized by amyloid-β aggregation in the media and adventitia of the leptomeningeal and cortical blood vessels. CAA is one of the strongest vascular contributors to Alzheimer's disease (AD). It frequently co-occurs in AD patients, but the relationship between CAA and AD is incompletely understood. CAA may drive AD risk through damage to the neurovascular unit and accelerate parenchymal amyloid and tau deposition. Conversely, early AD may also drive CAA through cerebrovascular remodeling that impairs blood vessels from clearing amyloid-β. Sole reliance on autopsy examination to study CAA limits researchers' ability to investigate CAA's natural disease course and the effect of CAA on cognitive decline. Neuroimaging allows for in vivo assessment of brain function and structure and can be leveraged to investigate CAA staging and explore its associations with AD. In this review, we will discuss neuroimaging modalities that can be used to investigate markers associated with CAA that may impact AD vulnerability including hemorrhages and microbleeds, blood-brain barrier permeability disruption, reduced cerebral blood flow, amyloid and tau accumulation, white matter tract disruption, reduced cerebrovascular reactivity, and lowered brain glucose metabolism. We present possible areas for research inquiry to advance biomarker discovery and improve diagnostics.
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Affiliation(s)
- Koral V Wheeler
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina Del Rey, CA, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, USC Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Corwin D. Denney Research Center, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Meredith N Braskie
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina Del Rey, CA, USA
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Onofrj M, Russo M, Delli Pizzi S, De Gregorio D, Inserra A, Gobbi G, Sensi SL. The central role of the Thalamus in psychosis, lessons from neurodegenerative diseases and psychedelics. Transl Psychiatry 2023; 13:384. [PMID: 38092757 PMCID: PMC10719401 DOI: 10.1038/s41398-023-02691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/06/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
The PD-DLB psychosis complex found in Parkinson's disease (PD) and Dementia with Lewy Bodies (DLB) includes hallucinations, Somatic Symptom/Functional Disorders, and delusions. These disorders exhibit similar presentation patterns and progression. Mechanisms at the root of these symptoms also share similarities with processes promoting altered states of consciousness found in Rapid Eye Movement sleep, psychiatric disorders, or the intake of psychedelic compounds. We propose that these mechanisms find a crucial driver and trigger in the dysregulated activity of high-order thalamic nuclei set in motion by ThalamoCortical Dysrhythmia (TCD). TCD generates the loss of finely tuned cortico-cortical modulations promoted by the thalamus and unleashes the aberrant activity of the Default Mode Network (DMN). TCD moves in parallel with altered thalamic filtering of external and internal information. The process produces an input overload to the cortex, thereby exacerbating DMN decoupling from task-positive networks. These phenomena alter the brain metastability, creating dreamlike, dissociative, or altered states of consciousness. In support of this hypothesis, mind-altering psychedelic drugs also modulate thalamic-cortical pathways. Understanding the pathophysiological background of these conditions provides a conceptual bridge between neurology and psychiatry, thereby helping to generate a promising and converging area of investigation and therapeutic efforts.
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Affiliation(s)
- Marco Onofrj
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
| | - Mirella Russo
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Stefano Delli Pizzi
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Danilo De Gregorio
- Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Inserra
- Neurobiological Psychiatry Unit, McGill University, Montreal, QC, Canada
| | - Gabriella Gobbi
- Neurobiological Psychiatry Unit, McGill University, Montreal, QC, Canada
| | - Stefano L Sensi
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology - CAST, Institute for Advanced Biomedical Technology-ITAB University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.
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Townsend LTJ, Anderson KN, Boeve BF, McKeith I, Taylor JP. Sleep disorders in Lewy body dementia: Mechanisms, clinical relevance, and unanswered questions. Alzheimers Dement 2023; 19:5264-5283. [PMID: 37392199 DOI: 10.1002/alz.13350] [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: 12/21/2022] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 07/03/2023]
Abstract
In Lewy body dementia (LBD), disturbances of sleep and/or arousal including insomnia, excessive daytime sleepiness, rapid eye movement (REM) sleep behavior disorder, obstructive sleep apnea, and restless leg syndrome are common. These disorders can each exert a significant negative impact on both patient and caregiver quality of life; however, their etiology is poorly understood. Little guidance is available for assessing and managing sleep disorders in LBD, and they remain under-diagnosed and under-treated. This review aims to (1) describe the specific sleep disorders which occur in LBD, considering their putative or potential mechanisms; (2) describe the history and diagnostic process for these disorders in LBD; and (3) summarize current evidence for their management in LBD and consider some of the ongoing and unanswered questions in this field and future research directions.
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Affiliation(s)
- Leigh T J Townsend
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kirstie N Anderson
- Regional Sleep Service, Newcastle-upon-Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian McKeith
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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McKiernan E, Su L, O'Brien J. MRS in neurodegenerative dementias, prodromal syndromes and at-risk states: A systematic review of the literature. NMR IN BIOMEDICINE 2023; 36:e4896. [PMID: 36624067 DOI: 10.1002/nbm.4896] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 12/21/2022] [Accepted: 01/04/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND In recent years, MRS has benefited from increased MRI field strengths, new acquisition protocols and new processing techniques. This review aims to determine how this has altered our understanding of MRS neurometabolic markers in neurodegenerative dementias. METHODS Our systematic review of human in vivo MRS literature since 2002 pertains to Alzheimer's disease (AD), dementia with Lewy bodies (DLB), Parkinson's disease dementia, frontotemporal dementia (FTD), prodromal and 'at-risk' states. Studies using field strengths of 3 T or more were included. RESULTS Of 85 studies, AD and/or mild cognitive impairment (MCI) were the most common conditions of interest (58 papers, 68%). Only 14 (16%) studies included other dementia syndromes and 13 (15%) investigated 'at-risk' cohorts. Earlier findings of lower N-acetylaspartate and higher myo-inositol were confirmed. Additionally, lower choline and creatine in AD and MCI were reported, though inconsistently. Previously challenging-to-measure metabolites (glutathione, glutamate and gamma-aminobutyric acid) were reportedly lower in AD, FTD and DLB compared with controls. DISCUSSION Increasing field strength alongside targeted acquisition protocols has revealed additional metabolite changes. Most studies were small and regional metabolite differences between dementia types may not have been captured due to the predominant placement of voxels in the posterior cingulate cortex. The standard of data collection, quality control and analysis is improving due to greater consensus regarding acquisition and processing techniques. Ongoing harmonization of techniques, creation of larger and longitudinal cohorts, and placement of MRS voxels in more diverse regions will strengthen future research.
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Affiliation(s)
- Elizabeth McKiernan
- Department of Psychiatry, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Li Su
- Department of Psychiatry, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
- Neuroscience Institute, University of Sheffield, Sheffield, UK
| | - John O'Brien
- Department of Psychiatry, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
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Caminiti SP, Pilotto A, Premi E, Galli A, Ferrari E, Gipponi S, Cottini E, Paghera B, Perani D, Padovani A. Dopaminergic connectivity reconfiguration in the dementia with Lewy bodies continuum. Parkinsonism Relat Disord 2023; 108:105288. [PMID: 36724569 DOI: 10.1016/j.parkreldis.2023.105288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The impairment of nigrostriatal dopaminergic network is a core feature of dementia with Lewy bodies (DLB). The involvement and reconfiguration of extranigrostriatal dopaminergic circuitries in the DLB continuum is still theme of debate. We aim to investigate in vivo the dynamic changes of local and long-distance dopaminergic networks across DLB continuum. METHODS Forty-nine patients (including 29 with dementia and 20 prodromal cases) and fifty-two controls entered the study. Each subject underwent a standardized clinical and neurological examination and performed Brain SPECT to measuring brain dopamine transporter (DAT) density. Spatially normalized images underwent the occipital-adjusted specific binding to obtain parametric data. The ANCOVA was applied to assess 123I-FP-CIT differences between pDLB, overt-DLB and CG, considering age, gender, and motor impairment as variables of no interest. Between-nodes correlation analysis measured molecular connectivity within the ventral and dorsal dopaminergic networks. RESULTS Prodromal DLB and DLB patients showed comparable nigrostriatal deficits in basal ganglia regions compared with CG. Molecular connectivity analyses revealed extensive connectivity losses, more in ventral than in dorsal dopaminergic network in DLB dementia. Conversely, the prodromal group showed increased connectivity compared to CG, mostly putamen-thalamus-cortical and striatal-cortical connectivity. CONCLUSIONS This study indicates a comparable basal ganglia deficit in nigrostriatal projections in DLB continuum and supports a different reorganization of extra-striatal dopaminergic connectivity in the prodromal phases of DLB. The shift from an increased to a decreased bilateral putamen-thalamus-cortex connectivity might be a hallmark of transition from prodromal to dementia DLB stages.
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Affiliation(s)
- Silvia Paola Caminiti
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Enrico Premi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Stroke Unit, Azienda Socio Sanitaria Territoriale Spedali Civili, Spedali Civili Hospital, Brescia, Italy
| | - Alice Galli
- Vita-Salute San Raffaele University, Milan, Italy; Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elisabetta Ferrari
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Gipponi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elisabetta Cottini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Barbara Paghera
- Nuclear Medicine Unit, University of Brescia, Brescia, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Stroke Unit, Azienda Socio Sanitaria Territoriale Spedali Civili, Spedali Civili Hospital, Brescia, Italy
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Zhang F, Rakhimbekova A, Lashley T, Madl T. Brain regions show different metabolic and protein arginine methylation phenotypes in frontotemporal dementias and Alzheimer's disease. Prog Neurobiol 2023; 221:102400. [PMID: 36581185 DOI: 10.1016/j.pneurobio.2022.102400] [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: 08/06/2022] [Revised: 11/05/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Abstract
Frontotemporal dementia (FTD) is a heterogeneous neurodegenerative disease with multiple histopathological subtypes. FTD patients share similar symptoms with Alzheimer's disease (AD). Hence, FTD patients are commonly misdiagnosed as AD, despite the consensus clinical diagnostic criteria. It is therefore of great clinical need to identify a biomarker that can distinguish FTD from AD and control individuals, and potentially further differentiate between FTD pathological subtypes. We conducted a metabolomic analysis on post-mortem human brain tissue from three regions: cerebellum, frontal cortex and occipital cortex from control, FTLD-TDP type A, type A-C9, type C and AD. Our results indicate that the brain subdivisions responsible for different functions show different metabolic patterns. We further explored the region-specific metabolic characteristics of different FTD subtypes and AD patients. Different FTD subtypes and AD share similar metabolic phenotypes in the cerebellum, but AD exhibited distinct metabolic patterns in the frontal and occipital regions compared to FTD. The identified brain region-specific metabolite biomarkers could provide a tool for distinguishing different FTD subtypes and AD and provide the first insights into the metabolic changes of FTLD-TDP type A, type A-C9, type C and AD in different regions of the brain. The importance of protein arginine methylation in neurodegenerative disease has come to light, so we investigated whether the arginine methylation level contributes to disease pathogenesis. Our findings provide new insights into the relationship between arginine methylation and metabolic changes in FTD subtypes and AD that could be further explored, to study the molecular mechanism of pathogenesis.
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Affiliation(s)
- Fangrong Zhang
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Research Unit Integrative Structural Biology, Medical University of Graz, 8010 Graz, Austria.
| | - Anastasia Rakhimbekova
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Research Unit Integrative Structural Biology, Medical University of Graz, 8010 Graz, Austria.
| | - Tammaryn Lashley
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK; Queen Square Brain Bank for Neurological Diseases, UCL Queen Square Institute of Neurology, London, UK.
| | - Tobias Madl
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Research Unit Integrative Structural Biology, Medical University of Graz, 8010 Graz, Austria; BioTechMed-Graz, 8010 Graz, Austria.
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Elder GJ, Lazar AS, Alfonso‐Miller P, Taylor J. Sleep disturbances in Lewy body dementia: A systematic review. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5814. [PMID: 36168299 PMCID: PMC9827922 DOI: 10.1002/gps.5814] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/13/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Lewy body dementia (LBD) refers to both dementia with Lewy bodies (DLB) and Parkinson's disease with dementia (PDD). Sleep disturbances are common in LBD, and can include poor sleep quality, excessive daytime sleepiness (EDS), and rapid eye movement behaviour disorder (RBD). Despite the high clinical prevalence of sleep disturbances in LBD, they are under-studied relative to other dementias. The aim of the present systematic review was to examine the nature of sleep disturbances in LBD, summarise the effect of treatment studies upon sleep, and highlight specific and necessary directions for future research. METHODS Published studies in English were located by searching PubMED and PSYCArticles databases (until 10 June 2022). The search protocol was pre-registered in PROSPERO (CRD42021293490) and performed in accordance with PRISMA guidelines. RESULTS Following full-text review, a final total of 70 articles were included. These included 20 studies focussing on subjective sleep, 14 on RBD, 8 on EDS, 7 on objective sleep, and 1 on circadian rhythms. The majority of the 18 treatment studies used pharmacological interventions (n = 12), had an open-label design (n = 8), and were of low-to-moderate quality. Most studies (n = 55) included only patients with DLB. Due to the heterogeneity of the studies, we reported a narrative synthesis without meta-analysis. CONCLUSIONS At least one form of sleep disturbance may be present in as many as 90% of people with LBD. Subjectively poor sleep quality, excessive daytime sleepiness, and RBD are more common and severe in LBD relative to other dementias.
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Affiliation(s)
- Greg J. Elder
- Northumbria Sleep ResearchDepartment of PsychologyFaculty of Health and Life SciencesNorthumbria UniversityNewcastle upon TyneUK
| | - Alpar S. Lazar
- Sleep and Brain Research UnitFaculty of Medicine and Health SciencesUniversity of East AngliaNorwichUK
| | - Pam Alfonso‐Miller
- Northumbria Sleep ResearchDepartment of PsychologyFaculty of Health and Life SciencesNorthumbria UniversityNewcastle upon TyneUK
| | - John‐Paul Taylor
- Translational and Clinical Research InstituteNewcastle UniversityCampus for Ageing and VitalityNewcastle Upon TyneUK
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Kai J, Khan AR, Haast RA, Lau JC. Mapping the subcortical connectome using in vivo diffusion MRI: Feasibility and reliability. Neuroimage 2022; 262:119553. [PMID: 35961469 DOI: 10.1016/j.neuroimage.2022.119553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/15/2022] [Accepted: 08/08/2022] [Indexed: 10/31/2022] Open
Abstract
Tractography combined with regions of interest (ROIs) has been used to non-invasively study the structural connectivity of the cortex as well as to assess the reliability of these connections. However, the subcortical connectome (subcortex to subcortex) has not been comprehensively examined, in part due to the difficulty of performing tractography in this complex and compact region. In this study, we performed an in vivo investigation using tractography to assess the feasibility and reliability of mapping known connections between structures of the subcortex using the test-retest dataset from the Human Connectome Project (HCP). We further validated our observations using a separate unrelated subjects dataset from the HCP. Quantitative assessment was performed by computing tract densities and spatial overlap of identified connections between subcortical ROIs. Further, known connections between structures of the basal ganglia and thalamus were identified and visually inspected, comparing tractography reconstructed trajectories with descriptions from tract-tracing studies. Our observations demonstrate both the feasibility and reliability of using a data-driven tractography-based approach to map the subcortical connectome in vivo.
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Affiliation(s)
- Jason Kai
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Ali R Khan
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Roy Am Haast
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada; Aix-Marseille University, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Jonathan C Lau
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada; Department of Clinical Neurological Sciences, Division of Neurosurgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.
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Carrarini C, De Rosa MA, Calisi D, Digiovanni A, Salute P, Dono F, Evangelista G, Consoli S, Russo M, Ferri L, D’Ardes D, Mattoli MV, Cipollone F, Onofrj M, Bonanni L. EEG Abnormalities During Delirium as a Prodromal Feature of Dementia with Lewy Bodies: A Case Report. J Alzheimers Dis Rep 2022; 6:223-228. [PMID: 35719713 PMCID: PMC9198785 DOI: 10.3233/adr-220017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background: A 79-year-old woman was admitted to the Neurology Clinic of the University of Chieti-Pescara for a syncope. At admission, the occurrence of an acute stroke was ruled out. Her cognitive status was unimpaired. After three days from the hospitalization, the patient experienced an episode of mixed delirium. Objective: The present case report shows a case of delirium-onset dementia with Lewy bodies (DLB) with a specific electroencephalographic (EEG) pattern from its prodromal stage. Methods: Delirium was assessed by 4AT test. During the hospitalization, the patient underwent a quantitative EEG (QEEG) with spectral analysis. At six months from the episode of delirium, she was tested by neuropsychological evaluation, QEEG, and 18F-fluorodeoxyglucose PET/CT to assess the onset of a possible cognitive decline. Results: At baseline, the QEEG exam showed a dominant frequency (DF) in the pre-alpha band (7.5 Hz) with a dominant frequency variability (DFV) of 2 Hz. This pattern is typical of DLB at early stage. After six months, she reported attention deficits in association with cognitive fluctuation and REM sleep behavior disorder. The neurological examination revealed signs of parkinsonism. Cognitive status resulted to be impaired (MoCA = 15/30). QEEG recording confirmed the presence of a DLB-typical pattern (DF = 7.5 Hz, DFV = 2.5 Hz). The 18F-FDG-PET/CT showed a moderate bilateral posterior hypometabolism (occipital and temporal cortex), with relative sparing of the posterior cingulate cortex compared to cuneus/precuneus (Cingulate Island sign), and mild bilateral hypometabolism in frontal regions (suggestive of a DLB diagnosis). Conclusion: EEGs may represent supportive and validated biomarkers for delirium-onset prodromal DLB.
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Affiliation(s)
- Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Matteo Alessandro De Rosa
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Dario Calisi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Anna Digiovanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | | | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Stefano Consoli
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Laura Ferri
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Damiano D’Ardes
- Department of Medicine and Aging Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Maria Vittoria Mattoli
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
- Nuclear Medicine Unit, Presidio Ospedaliero Santo Spirito, Pescara, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Medicine and Aging Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
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Mehraram R, Peraza LR, Murphy NRE, Cromarty RA, Graziadio S, O'Brien JT, Killen A, Colloby SJ, Firbank M, Su L, Collerton D, Taylor JP, Kaiser M. Functional and structural brain network correlates of visual hallucinations in Lewy body dementia. Brain 2022; 145:2190-2205. [PMID: 35262667 PMCID: PMC9246710 DOI: 10.1093/brain/awac094] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 12/02/2022] Open
Abstract
Visual hallucinations are a common feature of Lewy body dementia. Previous studies have shown that visual hallucinations are highly specific in differentiating Lewy body dementia from Alzheimer’s disease dementia and Alzheimer–Lewy body mixed pathology cases. Computational models propose that impairment of visual and attentional networks is aetiologically key to the manifestation of visual hallucinations symptomatology. However, there is still a lack of experimental evidence on functional and structural brain network abnormalities associated with visual hallucinations in Lewy body dementia. We used EEG source localization and network based statistics to assess differential topographical patterns in Lewy body dementia between 25 participants with visual hallucinations and 17 participants without hallucinations. Diffusion tensor imaging was used to assess structural connectivity between thalamus, basal forebrain and cortical regions belonging to the functionally affected network component in the hallucinating group, as assessed with network based statistics. The number of white matter streamlines within the cortex and between subcortical and cortical regions was compared between hallucinating and not hallucinating groups and correlated with average EEG source connectivity of the affected subnetwork. Moreover, modular organization of the EEG source network was obtained, compared between groups and tested for correlation with structural connectivity. Network analysis showed that compared to non-hallucinating patients, those with hallucinations feature consistent weakened connectivity within the visual ventral network, and between this network and default mode and ventral attentional networks, but not between or within attentional networks. The occipital lobe was the most functionally disconnected region. Structural analysis yielded significantly affected white matter streamlines connecting the cortical regions to the nucleus basalis of Meynert and the thalamus in hallucinating compared to not hallucinating patients. The number of streamlines in the tract between the basal forebrain and the cortex correlated with cortical functional connectivity in non-hallucinating patients, while a correlation emerged for the white matter streamlines connecting the functionally affected cortical regions in the hallucinating group. This study proposes, for the first time, differential functional networks between hallucinating and not hallucinating Lewy body dementia patients, and provides empirical evidence for existing models of visual hallucinations. Specifically, the outcome of the present study shows that the hallucinating condition is associated with functional network segregation in Lewy body dementia and supports the involvement of the cholinergic system as proposed in the current literature.
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Affiliation(s)
- Ramtin Mehraram
- Experimental Oto-rhino-laryngology (ExpORL) Research Group, Department of Neurosciences, KU Leuven, Leuven, Belgium.,NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | | | - Nicholas R E Murphy
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX 77030, USA.,The Menninger Clinic, Houston, TX, 77035, USA.,Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Ruth A Cromarty
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Sara Graziadio
- NIHR Newcastle in vitro Diagnostics Cooperative, Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK
| | - Alison Killen
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Sean J Colloby
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Li Su
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK.,Department of Neuroscience, The University of Sheffield, Sheffield, UK
| | - Daniel Collerton
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK.,NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Matar E, Brooks D, Lewis SJ, Halliday GM. Limbic thalamus atrophy is associated with visual hallucinations in Lewy body disorders. Neurobiol Aging 2022; 112:122-128. [DOI: 10.1016/j.neurobiolaging.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/04/2021] [Accepted: 01/03/2022] [Indexed: 01/22/2023]
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12
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Chabran E, Mondino M, Noblet V, Degiorgis L, Loureiro de Sousa P, Blanc F. Microstructural changes in prodromal dementia with Lewy bodies compared to normal aging: multiparametric quantitative MRI evidences. Eur J Neurosci 2021; 55:611-623. [PMID: 34888964 DOI: 10.1111/ejn.15558] [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: 05/09/2021] [Revised: 11/08/2021] [Accepted: 11/20/2021] [Indexed: 11/29/2022]
Abstract
Dementia with Lewy bodies (DLB) patients show few significant macroscopic structural changes, especially at the early stages of the disease, making quantitative MRI especially interesting to explore more subtle changes that are not detectable by conventional volumetric techniques. Microstructural alterations have been reported in DLB at the dementia stage, but no study to date was conducted in prodromal patients. Here, quantitative MRI data were collected from 46 DLB prodromal patients and 20 healthy elderly subjects, who also underwent a detailed clinical examination including the Mayo Clinic Fluctuation Scale. We conducted voxel-wise between-group comparisons in diffusion tensor imaging (DTI) metrics and in R2* mapping, along with a multivariate analysis combining the two modalities. We highlighted multiple grey matter and white matter microstructural changes in DLB patients at the prodromal stage, compared to control subjects. Our multivariate analysis identified three distinct regional patterns of DTI and R2* changes (anterior, anteromedial, posterior) in DLB patients, that could reflect different neuropathological processes across brain regions. We also observed an association between R2* alterations in the thalamus, and the severity of fluctuations, in the DLB group. These preliminary findings are promising and require future investigations to better understand the biological underpinnings of microstructural alterations.
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Affiliation(s)
- Eléna Chabran
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS team and IRIS plateform, University of Strasbourg and CNRS, Strasbourg, France
| | - Mary Mondino
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS team and IRIS plateform, University of Strasbourg and CNRS, Strasbourg, France
| | - Vincent Noblet
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS team and IRIS plateform, University of Strasbourg and CNRS, Strasbourg, France
| | - Laetitia Degiorgis
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS team and IRIS plateform, University of Strasbourg and CNRS, Strasbourg, France
| | - Paulo Loureiro de Sousa
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS team and IRIS plateform, University of Strasbourg and CNRS, Strasbourg, France
| | - Frédéric Blanc
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), IMIS team and IRIS plateform, University of Strasbourg and CNRS, Strasbourg, France.,CM2R (Research and Resources Memory Centre), Geriatric Day Hospital and Neuropsychology Unit, Geriatrics Department, University Hospitals of Strasbourg, Strasbourg, France
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13
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Liu H, Zhang D, Lin H, Zhang Q, Zheng L, Zheng Y, Yin X, Li Z, Liang S, Huang S. Meta-Analysis of Neurochemical Changes Estimated via Magnetic Resonance Spectroscopy in Mild Cognitive Impairment and Alzheimer's Disease. Front Aging Neurosci 2021; 13:738971. [PMID: 34744689 PMCID: PMC8569809 DOI: 10.3389/fnagi.2021.738971] [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: 07/09/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
The changes of neurochemicals in mild cognitive impairment (MCI) and Alzheimer's disease (AD) patients has been observed via magnetic resonance spectroscopy in several studies. However, whether it exists the consistent pattern of changes of neurochemicals in the encephalic region during the progression of MCI to AD were still not clear. The study performed meta-analysis to investigate the patterns of neurochemical changes in the encephalic region in the progress of AD. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases, and finally included 63 studies comprising 1,086 MCI patients, 1,256 AD patients, and 1,907 healthy controls. It showed that during the progression from MCI to AD, N-acetyl aspartate (NAA) decreased continuously in the posterior cingulate (PC) (SMD: −0.42 [95% CI: −0.62 to −0.21], z = −3.89, P < 0.05), NAA/Cr (creatine) was consistently reduced in PC (SMD: −0.58 [95% CI: −0.86 to −0.30], z = −4.06, P < 0.05) and hippocampus (SMD: −0.65 [95% CI: −1.11 to −0.12], z = −2.44, P < 0.05), while myo-inositol (mI) (SMD: 0.44 [95% CI: 0.26–0.61], z = 4.97, P < 0.05) and mI/Cr (SMD: 0.43 [95% CI: 0.17–0.68], z = 3.30, P < 0.05) were raised in PC. Furthermore, these results were further verified by a sustained decrease in the NAA/mI of PC (SMD: −0.94 [95% CI: −1.24 to −0.65], z = −6.26, P < 0.05). Therefore, the levels of NAA and mI were associated with the cognitive decline and might be used as potentially biomarkers to predict the possible progression from MCI to AD. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020200308.
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Affiliation(s)
- Huanhuan Liu
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Dandan Zhang
- College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huawei Lin
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Qi Zhang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ling Zheng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yuxin Zheng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiaolong Yin
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zuanfang Li
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fuzhou, China
| | - Shengxiang Liang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Saie Huang
- Department of Neurological Rehabilitation, Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital, Fuzhou, China
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14
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Onofrj M, Russo M, Carrarini C, Delli Pizzi S, Thomas A, Bonanni L, Espay AJ, Sensi SL. Functional neurological disorder and somatic symptom disorder in Parkinson's disease. J Neurol Sci 2021; 433:120017. [PMID: 34629180 DOI: 10.1016/j.jns.2021.120017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/02/2021] [Accepted: 09/29/2021] [Indexed: 11/15/2022]
Abstract
The occurrence of Functional Neurological Disorder (FND) and Somatic Symptom Disorder (SSD) in PD was not commonly accepted until recently, despite some evidence that emerged in the pre and early L-Dopa era. More recently, the recognition of FND and SSD were noted to be relevant for the management of PD. FND and SSD appear early in the course of PD, often preceding motor symptoms, may interfere with treatment outcomes, often acquire psychotic features during progression, and are mixed with and often concealed by the progressive cognitive decline. We review the related features from the range of the available reports and discuss theoretical models conceived to explain the potential pathophysiological background of these disorders. Finally, we suggest that FND and SSD should be included among the non-motor symptoms of PD and be considered a prodromal feature in a subset of patients. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Molecular Neurology and Behavioral Neurology Units, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Astrid Thomas
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Molecular Neurology and Behavioral Neurology Units, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Molecular Neurology and Behavioral Neurology Units, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Institute for Mind Impairments and Neurological Disorders-iMIND, University of California, Irvine, Irvine, CA, United States.
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15
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Frings L, Heimbach B, Meyer PT, Hellwig S. Intrinsic Alertness Is Impaired in Patients with Nigrostriatal Degeneration: A Prospective Study with Reference to [123I]FP-CIT SPECT and [18F]FDG PET. J Alzheimers Dis 2021; 78:1721-1729. [PMID: 33216022 DOI: 10.3233/jad-191277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Variations in alertness and attention are common in Lewy body diseases (LBD) and among the core features of dementia with Lewy bodies (DLB). Dopamine transporter SPECT is an accurate biomarker of nigrostriatal degeneration (NSD) in LBD. OBJECTIVE The present study investigated performance on a computerized alertness test as a potential measure of attention in patients with NSD compared to patients without NSD. METHODS Thirty-six patients with cognitive impairment plus at least one core feature of DLB referred for [123I]FP-CIT SPECT imaging were prospectively recruited. Performance in a computerized test of intrinsic alertness was compared between patients with and those without NSD as assessed by [123I]FP-CIT SPECT. RESULTS Reaction times to auditory stimuli (adjusted for age, sex, and education) were significantly longer in patients with NSD compared to those with a normal [123I]FP-CIT SPECT scan (p < 0.05). Statistical analyses revealed no significant differences comparing reaction times to visual stimuli or dispersion of reaction times between groups. Exploratory analysis in a subgroup of patients with available [18F]FDG PET revealed that longer reaction times were associated with decreased glucose metabolism in the prefrontal cortex (statistical parametric mapping, adjusted for age and sex; p < 0.005, cluster extent > 50 voxels). CONCLUSION Computerized assessment of auditory reaction times is able to detect alertness deficits in patients with NSD and might help to measure alertness deficits in patients with LBD and NSD. Future studies in larger samples are needed to evaluate the diagnostic utility of computerized alertness assessment for the differential diagnosis of LBD.
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Affiliation(s)
- Lars Frings
- Center of Geriatrics and Gerontology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.,Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Bernhard Heimbach
- Center of Geriatrics and Gerontology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Philipp T Meyer
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Sabine Hellwig
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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16
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Zorzi G, Thiebaut de Schotten M, Manara R, Bussè C, Corbetta M, Cagnin A. White matter abnormalities of right hemisphere attention networks contribute to visual hallucinations in dementia with Lewy bodies. Cortex 2021; 139:86-98. [PMID: 33848693 DOI: 10.1016/j.cortex.2021.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/16/2021] [Accepted: 03/04/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Functional alterations of the visual attention networks in a setting of impaired visual information processing have a role in the genesis of visual hallucinations (VH) in dementia with Lewy bodies (DLB). This multimodal MRI study aims at exploring structural and functional basis of VH. METHODS 23 DLB patients (10 with and 13 without VH) and 13 healthy controls were studied. They underwent MRI with T1-w sequences to measure cortical thickness, DTI for whole-brain and single tract microstructural properties and rs-fMRI of the default mode, dorsal and ventral attention, and visual networks. RESULTS In DLB with VH, whole-brain DTI revealed a lower fractional anisotropy and a greater mean diffusivity in the right frontal and temporo-parietal white matter tracts. Tracts dissection showed lower fractional anisotropy in the right inferior and superior (ventral part) longitudinal fasciculi (ILF and SLF) (p < .05, corrected), and greater mean diffusivity (p < .05). The extent of white matter microstructural alterations involving the right ILF and SLF correlated with the severity of VH (r = .55, p < .01; r = .42, p < .05, respectively), and with performance in the visual attention task (r = -.56 and r = -.61; p < .01, respectively). Cortical thickness in the projection areas of the right SLF was significantly reduced (p < .05). Patients with VH also showed an altered functional connectivity in the ventral attention network, connected by the ventral portion of the SLF (p < .05). CONCLUSIONS Our findings suggest that a combination of microstructural and functional alterations involving the attention networks in the right hemisphere may be important in the genesis of VH.
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Affiliation(s)
- Giovanni Zorzi
- Department of Neuroscience, University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy.
| | - Michel Thiebaut de Schotten
- Padova Neuroscience Center, University of Padova, Padova, Italy; Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France; Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
| | - Renzo Manara
- Department of Neuroscience, University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Cinzia Bussè
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Maurizio Corbetta
- Department of Neuroscience, University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy; Department of Neurology, Radiology, Neuroscience, Washington University School of Medicine, St.Louis, MO, USA
| | - Annachiara Cagnin
- Department of Neuroscience, University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy
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17
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Carrarini C, Russo M, Pagliaccio G, Dono F, Franciotti R, Deluca G, Nanni S, Saracino A, Onofrj M, Bonanni L. Visual evoked potential abnormalities in dementia with Lewy bodies. Neurophysiol Clin 2021; 51:425-431. [PMID: 33653623 DOI: 10.1016/j.neucli.2021.02.003] [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: 09/02/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Visuo-perceptual deficits and visual hallucinations (VHs) are common disturbances in patients with dementia with Lewy bodies (DLB) and those with Parkinson's disease (PD). In particular, delays in visual evoked potential (VEP), reversed by l-dopa administration, have previously been observed in PD patients. Impairment in metabolic functions of dopaminergic amacrine cells within the inner plexiform layer of the retina has been largely documented and has been posited as the underlying cause of visual and retinal alterations in PD. The aims of the present study were to investigate the presence of VEP abnormalities in DLB patients, as compared to a PD control group, and to assess the presence of significant correlations between neurophysiological measures and clinical symptoms (i.e., presence of visuospatial deficits and/or visual hallucinations). METHODS Fifteen DLB patients and fifteen matched PD patients underwent pattern reversal before and after l-dopa administration, and a short neuropsychological assessment. RESULTS In DLB patients, we observed delay of the P100 latency to foveal stimuli in both eyes compared to normative values. Compared to PD, DLB patients showed higher values of the P100 latency for foveal stimulation from the right eye prior to l-dopa administration (p = 0.018). No correlations between VEP alterations, visuo-spatial deficit and visual hallucinations were found. DISCUSSION Our findings demonstrated a longer P100 delay in DLB than in PD patients, especially along the right visual pathway. In contrast to previous studies, which focused on a dopaminergic pre-geniculate impairment of visual pathways, our evidence suggests that other mechanisms, possibly relying on thalamic involvement, which is known to be dysfunctional in DLB, can interfere with VEP abnormalities.
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Affiliation(s)
- Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | | | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Raffaella Franciotti
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Giulia Deluca
- Department of Neurology, SS Annunziata Hospital, Chieti, Italy
| | - Stefania Nanni
- Department of Neurology, SS Annunziata Hospital, Chieti, Italy
| | | | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy; Department of Neurology, SS Annunziata Hospital, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy; Department of Neurology, SS Annunziata Hospital, Chieti, Italy.
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18
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Dementia with Lewy bodies and Parkinson’s disease dementia-two independent disorders or one clinical entity within a clinical spectrum of synucleinopathies? CURRENT PROBLEMS OF PSYCHIATRY 2021. [DOI: 10.2478/cpp-2020-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Introduction: Both dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) are important dementia syndromes that overlap in their clinical features and clinical course, neuropathological abnormalities, and also therapeutic approach. Nevertheless it is still unclear whether DLB and PDD are two different disorders that require differentiation or are one clinical entity within a spectrum of Lewy body disease. Currently these disorders are mainly distinguished on the basis of the relative timing of the onset of symptoms of dementia and parkinsonism. The present paper presents current concepts on the pathogenesis of both disorders and their possible overlap.
Material and methods: Online databases in the field of DLB and PDD were searched for to find potentially eligible articles. Only most recent articles published after the year 2000 were chosen.
Results: The clinical features of DLB and PDD are similar and include dementia with hallucinations and cognitive fluctuations, as well as parkinsonian signs. Also cognitive deficits are similar in PDD and in DLB, with predominance of executive dysfunction, visual-spatial deficits and memory impairment. Neuropathological changes in both disorders involve the presence of Lewy bodies and Lewy neurites within brainstem, limbic and neocortex, as well as loss of midbrain dopamine cells, and loss of cholinergic neurons in the nuclei of ventral forebrain.
Conclusions: Similarities in clinical manifestation, neuropsychological deficits and neuropathological abnormalities may suggest that both DLB and PDD are two different phenotypes of the same disorder. This review article presents current knowledge on similarities and differences between these two clinical entities and raises the question whether they require differentiation or not.
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19
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Koenig T, Smailovic U, Jelic V. Past, present and future EEG in the clinical workup of dementias. Psychiatry Res Neuroimaging 2020; 306:111182. [PMID: 32921526 DOI: 10.1016/j.pscychresns.2020.111182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/02/2020] [Accepted: 09/03/2020] [Indexed: 01/25/2023]
Abstract
Electroencephalography (EEG), as non-invasive, global measure of neuronal activity, is a prime candidate functional marker of synapse dysfunction and loss in dementias. Nevertheless, EEG currently has no established role in the clinical workup of individual patients. This opinion paper presents our critical view on why EEG has so far failed to keep its promise, and where we believe EEG will be clinically useful for patients threatened with cognitive decline in the future. Individual EEGs are an integral outcome of many causally intermixing upstream factors contributing to dementia. Therefore, EEG cannot become a clinically useful "simple" stand-alone biomarker of some pathognomic accumulations of specific brain proteins, but rather offer unique opportunities for more comprehensive and richly faceted insights into the functional status of brain systems. EEG may thus remain an essential window into the brain when it comes to the at-risk and presymptomatic phases of dementias, where it can be uniquely informative about concepts such as burdens of plasticity and repair, cognitive reserve, and sleep. Jointly with rapid gains in usability, portability, machine learning, closed loop systems, and understanding of the role of EEG-based sleep stages for memory and brain repair, EEG may come to keep its initial promise after all.
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Affiliation(s)
- Thomas Koenig
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
| | - Una Smailovic
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
| | - Vesna Jelic
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Karolinska University Hospital-Huddinge, Clinic for Cognitive Disorders, Stockholm, Sweden.
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20
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Carli G, Caminiti SP, Sala A, Galbiati A, Pilotto A, Ferini-Strambi L, Padovani A, Perani D. Impaired metabolic brain networks associated with neurotransmission systems in the α-synuclein spectrum. Parkinsonism Relat Disord 2020; 81:113-122. [DOI: 10.1016/j.parkreldis.2020.10.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/13/2020] [Accepted: 10/20/2020] [Indexed: 01/31/2023]
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21
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Dudchenko NG, Vasenina EE. [Fluctuation of cognitive functions in dementia with Lewy bodies]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:89-95. [PMID: 33205936 DOI: 10.17116/jnevro202012010289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Fluctuations of cognitive function (FCF) is one of the core diagnostic features of dementia with Lewy bodies (DLB). However, identification, pathophysiology, management of this unusual phenomena remain poor understood. The review presents modern ideas about phenomenology, causes, systematization, clinical significance and current methods of diagnosis and treatment of FCF in patients with DLB.
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Affiliation(s)
- N G Dudchenko
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - E E Vasenina
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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22
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Stylianou M, Zaaimi B, Thomas A, Taylor JP, LeBeau FEN. Early Disruption of Cortical Sleep-Related Oscillations in a Mouse Model of Dementia With Lewy Bodies (DLB) Expressing Human Mutant (A30P) Alpha-Synuclein. Front Neurosci 2020; 14:579867. [PMID: 33041770 PMCID: PMC7527476 DOI: 10.3389/fnins.2020.579867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/25/2020] [Indexed: 01/03/2023] Open
Abstract
Changes in sleep behavior and sleep-related cortical activity have been reported in conditions associated with abnormal alpha-synuclein (α-syn) expression, in particular Parkinson’s disease (PD) and dementia with Lewy bodies (DLB). Notably, changes can occur in patients years before the onset of cognitive decline. Sleep-related network oscillations play a key role in memory function, but how abnormal α-syn impacts the generation of such activity is currently unclear. To determine whether early changes in sleep-related network activity could also be observed, prior to any previously reported cognitive dysfunction, we used mice that over-express human mutant α-syn (A30P). Recordings in vivo were performed under urethane anesthesia in the medial prefrontal cortex (mPFC) and CA1 region of the hippocampus in young male (2.5 – 4 months old) A30P and age-matched wild type (WT) mice. We found that the slow oscillation (SO) < 1 Hz frequency was significantly faster in both the mPFC and hippocampus in A30P mice, and Up-state-associated fast oscillations at beta (20 – 30 Hz) and gamma (30 – 80 Hz) frequencies were delayed relative to the onset of the Up-state. Spindle (8 – 15 Hz) activity in the mPFC was also altered in A30P mice, as spindles were shorter in duration and had reduced density compared to WT. These changes demonstrate that dysregulation of sleep-related oscillations occurs in young A30P mice long before the onset of cognitive dysfunction. Our data suggest that, as seen in patients, changes in sleep-related oscillations are an early consequence of abnormal α-syn aggregation in A30P mice.
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Affiliation(s)
- Myrto Stylianou
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Boubker Zaaimi
- School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
| | - Alan Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona E N LeBeau
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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23
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Delli Pizzi S, Franciotti R, Ferretti A, Edden RA, Zöllner HJ, Esposito R, Bubbico G, Aiello C, Calvanese F, Sensi SL, Tartaro A, Onofrj M, Bonanni L. High
γ‐Aminobutyric
Acid Content Within the Medial Prefrontal Cortex Is a Functional Signature of Somatic Symptoms Disorder in Patients With Parkinson's Disease. Mov Disord 2020; 35:2184-2192. [DOI: 10.1002/mds.28221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/20/2020] [Accepted: 06/29/2020] [Indexed: 01/20/2023] Open
Affiliation(s)
- Stefano Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Institute for Advanced Biomedical Technologies (ITAB), “G. d'Annunzio” University Chieti‐Pescara Italy
- Center of Aging Sciences and Translational Medicine University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Raffaella Franciotti
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Institute for Advanced Biomedical Technologies (ITAB), “G. d'Annunzio” University Chieti‐Pescara Italy
- Center of Aging Sciences and Translational Medicine University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Antonio Ferretti
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Institute for Advanced Biomedical Technologies (ITAB), “G. d'Annunzio” University Chieti‐Pescara Italy
| | - Richard A.E. Edden
- Russell H. Morgan Department of Radiology The Johns Hopkins University School of Medicine Baltimore Maryland USA
- F.M. Kirby Center for Functional MRI Kennedy Krieger Institute Baltimore Maryland USA
| | - Helge J. Zöllner
- Russell H. Morgan Department of Radiology The Johns Hopkins University School of Medicine Baltimore Maryland USA
- F.M. Kirby Center for Functional MRI Kennedy Krieger Institute Baltimore Maryland USA
| | | | - Giovanna Bubbico
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Institute for Advanced Biomedical Technologies (ITAB), “G. d'Annunzio” University Chieti‐Pescara Italy
| | - Claudia Aiello
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Francesco Calvanese
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Stefano L. Sensi
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Center of Aging Sciences and Translational Medicine University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Armando Tartaro
- Department of Medical Sciences, Oral and Biotechnology University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Center of Aging Sciences and Translational Medicine University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Center of Aging Sciences and Translational Medicine University “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
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24
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O'Dowd S, Schumacher J, Burn DJ, Bonanni L, Onofrj M, Thomas A, Taylor JP. Fluctuating cognition in the Lewy body dementias. Brain 2020; 142:3338-3350. [PMID: 31411317 DOI: 10.1093/brain/awz235] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/28/2019] [Accepted: 06/09/2019] [Indexed: 01/17/2023] Open
Abstract
Fluctuating cognition is a core diagnostic feature of dementia with Lewy bodies and is also a key clinical feature of Parkinson's disease dementia. These dementias share common pathological features and are referred to as Lewy body dementias. Whilst highly prevalent in Lewy body dementia, with up to 90% of patients experiencing the symptom at some point in the disease trajectory, clinical identification of fluctuating cognition is often challenging. Furthermore, its underlying pathophysiological processes remain unclear. However, neuroimaging and neurophysiological techniques have recently provided insight into potential drivers of the phenomenon. In this update, we review data pertaining to clinical features and underlying mechanisms of fluctuating cognition in Lewy body dementia. We collate evidence for different proposed aetiologies: fluctuating cognition as an attentional disorder, as a consequence of loss of cholinergic drive, as a manifestation of failure in neuronal efficiency and synchrony, and as a disorder of sleep/arousal. We also review data relating to putative mechanisms that have received less attention to date. Increased understanding of fluctuating cognition may help to illuminate pathophysiological mechanisms in cognitive processing in Lewy body dementia, guide future research, and facilitate the design of targeted therapeutic approaches.
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Affiliation(s)
- Seán O'Dowd
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Department of Neurology, Tallaght University Hospital, Dublin 24, Ireland; Academic Unit of Neurology, Trinity College Dublin, Ireland
| | - Julia Schumacher
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - David J Burn
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Science and Aging Research Centre, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science and Aging Research Centre, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alan Thomas
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
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25
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Takahashi M, Uchihara T, Yoshida M, Wakabayashi K, Kakita A, Takahashi H, Toru S, Orimo S. Clinical and pathological features affecting cardiac sympathetic denervation in autopsy-confirmed dementia with Lewy bodies. Eur J Neurol 2020; 27:1155-1163. [PMID: 32239599 DOI: 10.1111/ene.14240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/09/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to clarify the features affecting cardiac sympathetic denervation in autopsy-confirmed dementia with Lewy bodies (DLB) patients. METHODS Fifty-four autopsy-confirmed DLB patients were enrolled. Tissue samples of the left ventricular anterior wall were immunostained with anti-tyrosine hydroxylase antibody to identify catecholaminergic nerve axons. Immunostained areas were quantified as residual cardiac sympathetic nerve (CSN) axons and the relationship between the degree of residual CSN axons and clinical and neuropathological features was examined. RESULTS Virtually all patients showed small amounts of residual CSN axons (0.87%, range 0.02%-9.98%), with 50 patients (92.6%) showing <2.0% of residual axons. The patients who showed psychological symptoms within the first year of the disease had significantly more residual CSN axons than the remaining patients did (1.50% vs. 0.40%, P < 0.01). Patients with a short disease duration and neocortical-type Lewy body pathology tended to have more preserved CSN axons, although this difference was not statistically significant. Fifty-three patients (98.1%) who had neurofibrillary tangles in the brain and strong concomitant Alzheimer's disease pathology also had statistically significantly more preserved CSN axons. The patient with the most preserved CSN axons showed different characteristics from the results, except for the first symptom. CONCLUSION Psychological symptoms within the first year of the disease, a short disease duration, neocortical-type Lewy body pathology and strong concomitant Alzheimer's disease pathology may be related to mild CSN degeneration in DLB patients. Thus, DLB patients with broad Lewy body pathology in the brain in the early stages may show mild CSN degeneration.
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Affiliation(s)
- M Takahashi
- Department of Neurology, Kanto Central Hospital of the Mutual Aid Association of Public-School Teachers, Tokyo, Japan
| | - T Uchihara
- Laboratory of Structural Neuropathology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Department of Neurology, Nitobe-Memorial Nakano General Hospital, Tokyo, Japan
| | - M Yoshida
- Institute for Medical Science of Aging, Aichi Medical University, Aichi, Japan
| | - K Wakabayashi
- Department of Neuropathology, Institute of Brain Science, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - A Kakita
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - H Takahashi
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - S Toru
- Department of Neurology, Nitobe-Memorial Nakano General Hospital, Tokyo, Japan
| | - S Orimo
- Department of Neurology, Kanto Central Hospital of the Mutual Aid Association of Public-School Teachers, Tokyo, Japan
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26
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Franciotti R, Pilotto A, Moretti DV, Falasca NW, Arnaldi D, Taylor JP, Nobili F, Kramberger M, Ptacek SG, Padovani A, Aarlsand D, Onofrj M, Bonanni L. Anterior EEG slowing in dementia with Lewy bodies: a multicenter European cohort study. Neurobiol Aging 2020; 93:55-60. [PMID: 32450445 DOI: 10.1016/j.neurobiolaging.2020.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 02/08/2023]
Abstract
Electroencephalography (EEG) slowing with prealpha dominant frequency (DF) in posterior derivations is a biomarker for dementia with Lewy bodies (DLB) diagnosis, in contrast with Alzheimer's disease (AD). However, an intrasubject re-evaluation of the original data, which contributed to the identification of EEG DLB biomarker, showed that DF was slower in anterior than posterior derivations. We suppose this anterior-posterior gradient of DF slowing could arise in DLB from a thalamocortical dysrhythmia, differently involving the anterior and posterior cortical areas, and correlating with cognitive impairment (Mini-Mental State Examination). EEG was recorded in 144 DLB, 116 AD, and 65 controls from 7 Centers of the European DLB Consortium. Spectra were divided into delta, theta, prealpha, alpha frequency bands. In DLB, mean DF was prealpha both anteriorly and posteriorly, but lower anteriorly (p < 0.001). In 14% of DLB, DF was prealpha anteriorly, whereas alpha posteriorly. In AD and controls, DF was constantly alpha. EEG slowing in DLB correlated with cognitive impairment. Thalamocortical dysrhythmia gives rise to prealpha rhythm with an anterior-posterior gradient and correlates with impaired cognition.
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Affiliation(s)
- Raffaella Franciotti
- Department of Neuroscience, Imaging and Clinical Science, and Aging Research Centre, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Davide V Moretti
- Alzheimer's Epidemiology and Rehabilitation in Alzheimer's Disease Operative Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Nicola Walter Falasca
- Department of Neuroscience, Imaging and Clinical Science, and Aging Research Centre, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Dario Arnaldi
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - John-Paul Taylor
- Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Flavio Nobili
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Milica Kramberger
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
| | - Sara Garcia Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, and Memory Clinic Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science, and Aging Research Centre, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Science, and Aging Research Centre, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.
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27
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Chabran E, Noblet V, Loureiro de Sousa P, Demuynck C, Philippi N, Mutter C, Anthony P, Martin-Hunyadi C, Cretin B, Blanc F. Changes in gray matter volume and functional connectivity in dementia with Lewy bodies compared to Alzheimer's disease and normal aging: implications for fluctuations. Alzheimers Res Ther 2020; 12:9. [PMID: 31907068 PMCID: PMC6945518 DOI: 10.1186/s13195-019-0575-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 12/23/2019] [Indexed: 12/02/2022]
Abstract
BACKGROUND Fluctuations are one of the core clinical features characterizing dementia with Lewy bodies (DLB). They represent a determining factor for its diagnosis and strongly impact the quality of life of patients and their caregivers. However, the neural correlates of this complex symptom remain poorly understood. This study aimed to investigate the structural and functional changes in DLB patients, compared to Alzheimer's disease (AD) patients and healthy elderly subjects, and their potential links with fluctuations. METHODS Structural and resting-state functional MRI data were collected from 92 DLB patients, 70 AD patients, and 22 control subjects, who also underwent a detailed clinical examination including the Mayo Clinic Fluctuation Scale. Gray matter volume changes were analyzed using whole-brain voxel-based morphometry, and resting-state functional connectivity was investigated using a seed-based analysis, with regions of interest corresponding to the main nodes of the salience network (SN), frontoparietal network (FPN), dorsal attention network (DAN), and default mode network (DMN). RESULTS At the structural level, fluctuation scores in DLB patients did not relate to the atrophy of insular, temporal, and frontal regions typically found in this pathology, but instead showed a weak correlation with more subtle volume reductions in different regions of the cholinergic system. At the functional level, the DLB group was characterized by a decreased connectivity within the SN and attentional networks, while the AD group showed decreases within the SN and DMN. In addition, higher fluctuation scores in DLB patients were correlated to a greater connectivity of the SN with the DAN and left thalamus, along with a decreased connectivity between the SN and DMN, and between the right thalamus and both the FPN and DMN. CONCLUSIONS Functional connectivity changes, rather than significant gray matter loss, could play an important role in the emergence of fluctuations in DLB. Notably, fluctuations in DLB patients appeared to be related to a disturbed external functional connectivity of the SN, which may lead to less relevant transitions between different cognitive states in response to internal and environmental stimuli. Our results also suggest that the thalamus could be a key region for the occurrence of this symptom.
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Affiliation(s)
- Eléna Chabran
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Vincent Noblet
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Paulo Loureiro de Sousa
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Catherine Demuynck
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Nathalie Philippi
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Catherine Mutter
- INSERM Centre d’Investigation Clinique 1434, University Hospitals of Strasbourg, Strasbourg, France
| | - Pierre Anthony
- General Hospital Centre, Geriatrics Department, CM2R, Geriatric Day Hospital, Colmar, France
| | - Catherine Martin-Hunyadi
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Benjamin Cretin
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Frédéric Blanc
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
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28
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Maul S, Giegling I, Rujescu D. Proton Magnetic Resonance Spectroscopy in Common Dementias-Current Status and Perspectives. Front Psychiatry 2020; 11:769. [PMID: 32848938 PMCID: PMC7424040 DOI: 10.3389/fpsyt.2020.00769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
Dementia occurs mainly in the elderly and is associated with cognitive decline and impairment of activities of daily living. The most common forms of dementia are Alzheimer's disease (AD), vascular dementia (VD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD). To date, there are no causal options for therapy, but drug and non-drug treatments can positively modulate the course of the disease. Valid biomarkers are needed for the earliest possible and reliable diagnosis, but so far, such biomarkers have only been established for AD and require invasive and expensive procedures. In this context, proton magnetic resonance spectroscopy (1H-MRS) provides a non-invasive and widely available technique for investigating the biochemical milieu of brain tissue in vivo. Numerous studies have been conducted for AD, but for VD, DLB, and FTD the number of studies is limited. Nevertheless, MRS can detect measurable metabolic alterations in common dementias. However, most of the studies conducted are too heterogeneous to assess the potential use of MRS technology in clinical applications. In the future, technological advances may increase the value of MRS in dementia diagnosis and treatment. This review summarizes the results of MRS studies conducted in common dementias and discusses the reasons for the lack of transfer into clinical routine.
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Affiliation(s)
- Stephan Maul
- University Clinic and Outpatient Clinic for Psychiatry, Psychotherapy and Psychosomatics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Ina Giegling
- University Clinic and Outpatient Clinic for Psychiatry, Psychotherapy and Psychosomatics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Dan Rujescu
- University Clinic and Outpatient Clinic for Psychiatry, Psychotherapy and Psychosomatics, Martin Luther University Halle-Wittenberg, Halle, Germany
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29
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Ma WY, Yao Q, Hu GJ, Xiao CY, Shi JP, Chen J. Dysfunctional Dynamics of Intra- and Inter-network Connectivity in Dementia With Lewy Bodies. Front Neurol 2019; 10:1265. [PMID: 31849824 PMCID: PMC6902076 DOI: 10.3389/fneur.2019.01265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/15/2019] [Indexed: 12/28/2022] Open
Abstract
Dementia with Lewy bodies (DLB) is characterized by the transient fluctuating cognition and recurrent visual hallucinations, which may be caused by disorders of the intrinsic brain network dynamics. However, little is known regarding the dynamic features of the brain network behind these symptoms in DLB. In the present study, the intra- and inter-brain network dynamics were explored on a time scale in 17 DLB and 20 healthy controls (HC) applying a sliding-window method followed by k-means clustering analysis. To further evaluate the impact of network dynamics on brain performance, the local and global efficiency of the brain network was calculated. Compared with HC, the dynamic functional connectivity variation matrix in DLB patients was represented by a mixed change of intra-network increase and inter-network decrease. DLB patients devoted more time to a negative connectivity pattern, which represents a state of functional separation. Furthermore, the local efficiency of DLB patients was significantly lower compared with HC. These observations indicate an altered dynamic variability and disorders to the time allocation of state sequences in DLB, which might result in a disturbance of the intricate brain network dynamic properties, thereby leading to a lack of integration and flexibility and an ineffective brain function. In conclusion, dynamic functional connectivity analysis could identify differences between DLB and HC, providing evidences for DLB diagnosis and contributing to the understanding of the widespread clinical features and complex treatment strategies in DLB patients.
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Affiliation(s)
- Wen-Ying Ma
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qun Yao
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Guan-Jie Hu
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chao-Yong Xiao
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jing-Ping Shi
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.,Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, China
| | - Jiu Chen
- Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, China.,Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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30
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Ikenouchi Y, Kamagata K, Andica C, Hatano T, Ogawa T, Takeshige-Amano H, Kamiya K, Wada A, Suzuki M, Fujita S, Hagiwara A, Irie R, Hori M, Oyama G, Shimo Y, Umemura A, Hattori N, Aoki S. Evaluation of white matter microstructure in patients with Parkinson's disease using microscopic fractional anisotropy. Neuroradiology 2019; 62:197-203. [PMID: 31680195 DOI: 10.1007/s00234-019-02301-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Micro fractional anisotropy (μFA) is more accurate than conventional fractional anisotropy (FA) for assessing microscopic tissue properties and can overcome limitations related to crossing white matter fibres. We compared μFA and FA for evaluating white matter changes in patients with Parkinson's disease (PD). METHODS We compared FA and μFA measures between 25 patients with PD and 25 age- and gender-matched healthy controls using tract-based spatial statistics (TBSS) analysis. We also examined potential correlations between changes, revealed by conventional FA or μFA, and disease duration or Unified Parkinson's Disease Rating Scale (UPDRS)-III scores. RESULTS Compared with healthy controls, patients with PD had significantly reduced μFA values, mainly in the anterior corona radiata (ACR). In the PD group, μFA values (primarily those from the ACR) were significantly negatively correlated with UPDRS-III motor scores. No significant changes or correlations with disease duration or UPDRS-III scores with tissue properties were detected using conventional FA. CONCLUSION μFA can evaluate microstructural changes that occur during white matter degeneration in patients with PD and may overcome a key limitation of FA.
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Affiliation(s)
- Yutaka Ikenouchi
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Christina Andica
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Taku Hatano
- Department of Neurology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takashi Ogawa
- Department of Neurology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Haruka Takeshige-Amano
- Department of Neurology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kouhei Kamiya
- Department of Radiology, The University of Tokyo Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Akihiko Wada
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Michimasa Suzuki
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shohei Fujita
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ryusuke Irie
- Department of Radiology, The University of Tokyo Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Masaaki Hori
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Genko Oyama
- Department of Neurology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yashushi Shimo
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Atsushi Umemura
- Department of Neurosurgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Matar E, Shine JM, Halliday GM, Lewis SJG. Cognitive fluctuations in Lewy body dementia: towards a pathophysiological framework. Brain 2019; 143:31-46. [DOI: 10.1093/brain/awz311] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/21/2019] [Accepted: 08/16/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Fluctuating cognition is a complex and disabling symptom that is seen most frequently in the context of Lewy body dementias encompassing dementia with Lewy bodies and Parkinson’s disease dementia. In fact, since their description over three decades ago, cognitive fluctuations have remained a core diagnostic feature of dementia with Lewy bodies, the second most common dementia in the elderly. In the absence of reliable biomarkers for Lewy body pathology, the inclusion of such patients in therapeutic trials depends on the accurate identification of such core clinical features. Yet despite their diagnostic relevance, cognitive fluctuations remain poorly understood, in part due to the lack of a cohesive clinical and scientific explanation of the phenomenon itself. Motivated by this challenge, the present review examines the history, clinical phenomenology and assessment of cognitive fluctuations in the Lewy body dementias. Based on these data, the key neuropsychological, neurophysiological and neuroimaging correlates of cognitive fluctuations are described and integrated into a novel testable heuristic framework from which new insights may be gained.
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Affiliation(s)
- Elie Matar
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - James M Shine
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Glenda M Halliday
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia
| | - Simon J G Lewis
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
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Lo Buono V, Palmeri R, Corallo F, Allone C, Pria D, Bramanti P, Marino S. Diffusion tensor imaging of white matter degeneration in early stage of Alzheimer's disease: a review. Int J Neurosci 2019; 130:243-250. [PMID: 31549530 DOI: 10.1080/00207454.2019.1667798] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Object: Alzheimer's disease is a progressive, irreversible neurodegenerative disorder associated with brain alterations. Diffusion tensor imaging (DTI) has contributed to identify degeneration in white matter cortical microstructural that can be considered an early and specific biomarker for Alzheimer's disease. This review aimed to provide a summary of DTI studies on white matter damage in Alzheimer's disease.Methods: On PubMed, Web of Science and Scopus databases, we reviewed the studies that used DTI for assessing fractional anisotropy in neurofiber tracts involved in Alzheimer's Disease progression: fornix, the cingulum, uncinate fasciculus, superior and inferior longitudinal fasciculus and corpus callosum. We included nine studies that met search criteria.Results: The results showed decreased fractional anisotropy value in mild cognitive impairment (MCI) patients. White matter diffusivity changes were associated with the progression of Alzheimer's disease.Conclusion: Microstructural alterations of the limbic and cortico-cortical tracts could be potential biomarkers for early diagnosis in preclinical disease phase.
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Affiliation(s)
| | | | | | | | - Deborah Pria
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | | | - Silvia Marino
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
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Onofrj M, Espay AJ, Bonanni L, Delli Pizzi S, Sensi SL. Hallucinations, somatic-functional disorders of PD-DLB as expressions of thalamic dysfunction. Mov Disord 2019; 34:1100-1111. [PMID: 31307115 DOI: 10.1002/mds.27781] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/30/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022] Open
Abstract
Hallucinations, delusions, and functional neurological manifestations (conversion and somatic symptom disorders) of Parkinson's disease (PD) and dementia with Lewy bodies increase in frequency with disease progression, predict the onset of cognitive decline, and eventually blend with and are concealed by dementia. These symptoms share the absence of reality constraints and can be considered comparable elements of the PD-dementia with Lewy bodies psychosis. We propose that PD-dementia with Lewy bodies psychotic disorders depend on thalamic dysfunction promoting a theta burst mode and subsequent thalamocortical dysrhythmia with focal cortical coherence to theta electroencephalogram rhythms. This theta electroencephalogram activity, also called fast-theta or pre-alpha, has been shown to predict cognitive decline and fluctuations in Parkinson's disease with dementia and dementia with Lewy bodies. These electroencephalogram alterations are now considered a predictive marker for progression to dementia. The resulting thalamocortical dysrhythmia inhibits the frontal attentional network and favors the decoupling of the default mode network. As the default mode network is involved in integration of self-referential information into conscious perception, unconstrained default mode network activity, as revealed by recent imaging studies, leads to random formation of connections that link strong autobiographical correlates to trivial stimuli, thereby producing hallucinations, delusions, and functional neurological disorders. The thalamocortical dysrhythmia default mode network decoupling hypothesis provides the rationale for the design and testing of novel therapeutic pharmacological and nonpharmacological interventions in the context of PD, PD with dementia, and dementia with Lewy bodies. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Alberto J Espay
- Department of Neurology, James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Stefano Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy.,Departments of Neurology and Pharmacology, Institute for Mind Impairments and Neurological Disorders, University of California - Irvine, Irvine, California, USA
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'Cognitive freezing': A newly recognized episodic phenomenon in Parkinson's disease. Parkinsonism Relat Disord 2019; 65:49-54. [PMID: 31178334 DOI: 10.1016/j.parkreldis.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/01/2019] [Accepted: 06/04/2019] [Indexed: 11/21/2022]
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35
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Esmaeeli S, Murphy K, Swords GM, Ibrahim BA, Brown JW, Llano DA. Visual hallucinations, thalamocortical physiology and Lewy body disease: A review. Neurosci Biobehav Rev 2019; 103:337-351. [PMID: 31195000 DOI: 10.1016/j.neubiorev.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 06/03/2019] [Accepted: 06/08/2019] [Indexed: 12/22/2022]
Abstract
One of the core diagnostic criteria for Dementia with Lewy Bodies (DLB) is the presence of visual hallucinations. The presence of hallucinations, along with fluctuations in the level of arousal and sleep disturbance, point to potential pathological mechanisms at the level of the thalamus. However, the potential role of thalamic dysfunction in DLB, particularly as it relates to the presence of formed visual hallucinations is not known. Here, we review the literature on the pathophysiology of DLB with respect to modern theories of thalamocortical function and attempt to derive an understanding of how such hallucinations arise. Based on the available literature, we propose that combined thalamic-thalamic reticular nucleus and thalamocortical pathology may explain the phenomenology of visual hallucinations in DLB. In particular, diminished α7 cholinergic activity in the thalamic reticular nucleus may critically disinhibit thalamocortical activity. Further, concentrated pathological changes within the posterior regions of the thalamus may explain the predilection for the hallucinations to be visual in nature.
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Affiliation(s)
- Shooka Esmaeeli
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Kathleen Murphy
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Gabriel M Swords
- University of Illinois at Chicago College of Medicine, Chicago, IL, United States
| | - Baher A Ibrahim
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Jeffrey W Brown
- University of Illinois at Chicago College of Medicine, Chicago, IL, United States
| | - Daniel A Llano
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Carle Neuroscience Institute, Urbana, IL, United States.
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36
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Schumacher J, Peraza LR, Firbank M, Thomas AJ, Kaiser M, Gallagher P, O’Brien JT, Blamire AM, Taylor JP. Dysfunctional brain dynamics and their origin in Lewy body dementia. Brain 2019; 142:1767-1782. [PMID: 30938426 PMCID: PMC6536851 DOI: 10.1093/brain/awz069] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/06/2019] [Accepted: 01/27/2019] [Indexed: 01/08/2023] Open
Abstract
Lewy body dementia includes dementia with Lewy bodies and Parkinson's disease dementia and is characterized by transient clinical symptoms such as fluctuating cognition, which might be driven by dysfunction of the intrinsic dynamic properties of the brain. In this context we investigated whole-brain dynamics on a subsecond timescale in 42 Lewy body dementia compared to 27 Alzheimer's disease patients and 18 healthy controls using an EEG microstate analysis in a cross-sectional design. Microstates are transiently stable brain topographies whose temporal characteristics provide insight into the brain's dynamic repertoire. Our additional aim was to explore what processes in the brain drive microstate dynamics. We therefore studied associations between microstate dynamics and temporal aspects of large-scale cortical-basal ganglia-thalamic interactions using dynamic functional MRI measures given the putative role of these subcortical areas in modulating widespread cortical function and their known vulnerability to Lewy body pathology. Microstate duration was increased in Lewy body dementia for all microstate classes compared to Alzheimer's disease (P < 0.001) and healthy controls (P < 0.001), while microstate dynamics in Alzheimer's disease were largely comparable to healthy control levels, albeit with altered microstate topographies. Correspondingly, the number of distinct microstates per second was reduced in Lewy body dementia compared to healthy controls (P < 0.001) and Alzheimer's disease (P < 0.001). In the dementia with Lewy bodies group, mean microstate duration was related to the severity of cognitive fluctuations (ρ = 0.56, PFDR = 0.038). Additionally, mean microstate duration was negatively correlated with dynamic functional connectivity between the basal ganglia (r = - 0.53, P = 0.003) and thalamic networks (r = - 0.38, P = 0.04) and large-scale cortical networks such as visual and motor networks in Lewy body dementia. The results indicate a slowing of microstate dynamics and disturbances to the precise timing of microstate sequences in Lewy body dementia, which might lead to a breakdown of the intricate dynamic properties of the brain, thereby causing loss of flexibility and adaptability that is crucial for healthy brain functioning. When contrasted with the largely intact microstate dynamics in Alzheimer's disease, the alterations in dynamic properties in Lewy body dementia indicate a brain state that is less responsive to environmental demands and might give rise to the apparent slowing in thinking and intermittent confusion which typify Lewy body dementia. By using Lewy body dementia as a probe pathology we demonstrate a potential link between dynamic functional MRI fluctuations and microstate dynamics, suggesting that dynamic interactions within the cortical-basal ganglia-thalamic loop might play a role in the modulation of EEG dynamics.
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Affiliation(s)
- Julia Schumacher
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Luis R Peraza
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Firbank
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
- Institute of Neuroscience, Newcastle University, The Henry Wellcome Building, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, The Henry Wellcome Building, Newcastle upon Tyne, UK
| | - John T O’Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK
| | - Andrew M Blamire
- Institute of Cellular Medicine and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
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Hansen D, Ling H, Lashley T, Holton JL, Warner TT. Review: Clinical, neuropathological and genetic features of Lewy body dementias. Neuropathol Appl Neurobiol 2019; 45:635-654. [PMID: 30977926 DOI: 10.1111/nan.12554] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/09/2019] [Indexed: 01/08/2023]
Abstract
Lewy body dementias are the second most common neurodegenerative dementias after Alzheimer's disease and include dementia with Lewy bodies and Parkinson's disease dementia. They share similar clinical and neuropathological features but differ in the time of dementia and parkinsonism onset. Although Lewy bodies are their main pathological hallmark, several studies have shown the emerging importance of Alzheimer's disease pathology. Clinical amyloid-β imaging using Pittsburgh Compound B (PiB) supports neuropathological studies which found that amyloid-β pathology is more common in dementia with Lewy bodies than in Parkinson's disease dementia. Nevertheless, other co-occurring pathologies, such as cerebral amyloid angiopathy, TDP-43 pathology and synaptic pathology may also influence the development of neurodegeneration and dementia. Recent genetic studies demonstrated an important role of APOE genotype and other genes such as GBA and SNCA which seem to be involved in the pathophysiology of Lewy body dementias. The aim of this article is to review the main clinical, neuropathological and genetic aspects of dementia with Lewy bodies and Parkinson's disease dementia. This is particularly relevant as future management for these two conditions may differ.
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Affiliation(s)
- D Hansen
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK
| | - H Ling
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T Lashley
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - J L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T T Warner
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
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38
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Pilotto A, Schiano di Cola F, Premi E, Grasso R, Turrone R, Gipponi S, Scalvini A, Cottini E, Paghera B, Garibotto V, Rizzetti MC, Bonanni L, Borroni B, Morbelli S, Nobili F, Guerra UP, Perani D, Padovani A. Extrastriatal dopaminergic and serotonergic pathways in Parkinson’s disease and in dementia with Lewy bodies: a 123I-FP-CIT SPECT study. Eur J Nucl Med Mol Imaging 2019; 46:1642-1651. [DOI: 10.1007/s00259-019-04324-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/31/2019] [Indexed: 02/07/2023]
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39
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Lin YW, Truong D. Diffuse Lewy body disease. J Neurol Sci 2019; 399:144-150. [PMID: 30807982 DOI: 10.1016/j.jns.2019.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 02/09/2019] [Accepted: 02/11/2019] [Indexed: 12/15/2022]
Abstract
Diffuse Lewy body disease, also called dementia with Lewy bodies (DLB), is defined as progressive dementia and pathological Lewy bodies distributed in the central and autonomic nervous systems. The clinical features are dementia, cognitive fluctuations, visual hallucinations, parkinsonism, and REM sleep behavior disorder (RBD). Confirmatory techniques include dopamine transporter imaging, meta-iodobenzylguanidine (MIBG) myocardial scintigraphy, and polysomnography. The pathology finding in DLB is misfolded alpha-synuclein, the main component of Lewy bodies, propagating in the central nervous system. This may interrupt the acetylcholine pathway and activate an inflammatory response. Mutations of several genes have been found in patients with DLB, including SNCA, GBA, and APOE. The differential diagnosis of DLB and Parkinson's disease with dementia (PDD) is a debated issue. Clinical features distinguishing DLB from PDD include the timing of dementia and visual hallucinations, responses to dopaminergic agents and anti-psychotics, and imaging findings. As to the management of DLB, cholinesterase inhibitors are the Level-A recommendation for treating dementia in DLB patients and also are beneficial for treating visual hallucinations and psychotic symptoms. Dopamine agonists have the risk of inducing psychotic symptoms, while levodopa should be used carefully for motor symptoms. Melatonin and clonazepam are effective in controlling RBD. Several other treatment methods are undergoing trials, including pimavanserine, nilotinib, psychological interventions, and behavior therapy.
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Affiliation(s)
- Yu Wei Lin
- Taiwan Adventist Hospital, Taipei, Taiwan
| | - Daniel Truong
- The Truong Neuroscience Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA, USA; Departments of Psychiatry and Neuroscience, UC Riverside, Riverside, CA, USA.
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40
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PD and DLB: Brain imaging in Parkinson's disease and dementia with Lewy bodies. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:167-185. [DOI: 10.1016/bs.pmbts.2019.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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41
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Balážová Z, Nováková M, Minsterová A, Rektorová I. Structural and Functional Magnetic Resonance Imaging of Dementia With Lewy Bodies. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 144:95-141. [PMID: 30638458 DOI: 10.1016/bs.irn.2018.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Dementia with Lewy bodies (DLB) is the second most common cause of neurodegenerative dementia after Alzheimer's disease (AD). Although diagnosis may be challenging, there is increasing evidence that the use of biomarkers according to 2017 revised criteria for diagnosis and management of dementia with Lewy bodies can increase diagnostic accuracy. Apart from nuclear medicine techniques, various magnetic resonance imaging (MRI) techniques have been utilized in attempt to enhance diagnostic accuracy. This chapter reviews structural, functional and diffusion MRI studies in DLB cohorts being compared to healthy controls, AD or dementia in Parkinson's disease (PDD). We also included relatively new MRI methods that may have potential to identify early DLB subjects and aim at examining brain iron and neuromelanin.
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Affiliation(s)
- Zuzana Balážová
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; Department of Radiology and Nuclear Medicine, University Hospital Brno, Faculty of Medicine, Brno, Czech Republic
| | - Marie Nováková
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic
| | - Alžběta Minsterová
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic
| | - Irena Rektorová
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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42
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Pelak VS, Berman BD. Transient Daily Episodes of Vision Loss Due to Parkinson's Disease. Neuroophthalmology 2018; 43:260-264. [PMID: 31528193 DOI: 10.1080/01658107.2018.1494202] [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: 06/13/2018] [Revised: 06/20/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022] Open
Abstract
Visual complaints are common in Parkinson's disease (PD), but transient visual loss has not previously been defined as a feature of parkinsonian-related disease. We report a patient with recurrent daily episodes of transient and disabling visual loss due to PD-related non-motor fluctuation. During his visit, he experienced one such episode, which allowed for close observation and examination during and after the visual loss. Implications for localization of the visual loss are reviewed in the context of visual pathway disturbances in PD.
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Affiliation(s)
- Victoria S Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brian D Berman
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
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43
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Quantitative electroencephalography as a marker of cognitive fluctuations in dementia with Lewy bodies and an aid to differential diagnosis. Clin Neurophysiol 2018; 129:1209-1220. [PMID: 29656189 PMCID: PMC5954167 DOI: 10.1016/j.clinph.2018.03.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/07/2018] [Accepted: 03/10/2018] [Indexed: 12/16/2022]
Abstract
EEG slowing was evident in dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) and less in Alzheimer’s disease (AD) patients compared to controls. Dominant rhythm variability was larger in AD but only correlated with cognitive fluctuations in DLB. QEEG variables classified DLB and AD patients with high sensitivity and specificity.
Objective We investigated for quantitative EEG (QEEG) differences between Alzheimer’s disease (AD), dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) patients and healthy controls, and for QEEG signatures of cognitive fluctuations (CFs) in DLB. Methods We analysed eyes-closed, resting state EEGs from 18 AD, 17 DLB and 17 PDD patients with mild dementia, and 21 age-matched controls. Measures included spectral power, dominant frequency (DF), frequency prevalence (FP), and temporal DF variability (DFV), within defined EEG frequency bands and cortical regions. Results DLB and PDD patients showed a leftward shift in the power spectrum and DF. AD patients showed greater DFV compared to the other groups. In DLB patients only, greater DFV and EEG slowing were correlated with CFs, measured by the clinician assessment of fluctuations (CAF) scale. The diagnostic accuracy of the QEEG measures was 94% (90.4–97.9%), with 92.26% (80.4–100%) sensitivity and 83.3% (73.6–93%) specificity. Conclusion Although greater DFV was only shown in the AD group, within the DLB group a positive DFV – CF correlation was found. QEEG measures could classify DLB and AD patients with high sensitivity and specificity. Significance The findings add to an expanding literature suggesting that EEG is a viable diagnostic and symptom biomarker in dementia, particularly DLB.
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Jellinger KA, Korczyn AD. Are dementia with Lewy bodies and Parkinson's disease dementia the same disease? BMC Med 2018; 16:34. [PMID: 29510692 PMCID: PMC5840831 DOI: 10.1186/s12916-018-1016-8] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/30/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), which share many clinical, neurochemical, and morphological features, have been incorporated into DSM-5 as two separate entities of major neurocognitive disorders with Lewy bodies. Despite clinical overlap, their diagnosis is based on an arbitrary distinction concerning the time of onset of motor and cognitive symptoms, namely as early cognitive impairment in DLB and later onset following that of motor symptoms in PDD. Their morphological hallmarks - cortical and subcortical α-synuclein/Lewy body plus β-amyloid and tau pathologies - are similar, but clinical differences at onset suggest some dissimilar profiles. Based on recent publications, including the fourth consensus report of the DLB Consortium, a critical overview is provided herein. DISCUSSION The clinical constellations of DLB and PDD include cognitive impairment, parkinsonism, visual hallucinations, and fluctuating attention. Intravitam PET and postmortem studies have revealed a more pronounced cortical atrophy, elevated cortical and limbic Lewy body pathologies, higher Aβ and tau loads in cortex and striatum in DLB compared to PDD, and earlier cognitive defects in DLB. Conversely, multitracer PET studies have shown no differences in cortical and striatal cholinergic and dopaminergic deficits. Clinical management of both DLB and PDD includes cholinesterase inhibitors and other pharmacologic and non-drug strategies, yet with only mild symptomatic effects. Currently, no disease-modifying therapies are available. CONCLUSION DLB and PDD are important dementia syndromes that overlap in many clinical features, genetics, neuropathology, and management. They are currently considered as subtypes of an α-synuclein-associated disease spectrum (Lewy body diseases), from incidental Lewy body disease and non-demented Parkinson's disease to PDD, DLB, and DLB with Alzheimer's disease at the most severe end. Cognitive impairment in these disorders is induced not only by α-synuclein-related neurodegeneration but by multiple regional pathological scores. Both DLB and PDD show heterogeneous pathology and neurochemistry, suggesting that they share important common underlying molecular pathogenesis with Alzheimer's disease and other proteinopathies. While we prefer to view DLB and PDD as extremes on a continuum, there remains a pressing need to more clearly differentiate these syndromes and to understand the synucleinopathy processes leading to either one.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150, Vienna, Austria.
| | - Amos D Korczyn
- Tel-Aviv University, Sackler Faculty of Medicine, Ramat Aviv, Israel
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Sun M, Mainland BJ, Ornstein TJ, Mallya S, Fiocco AJ, Sin GL, Shulman KI, Herrmann N. The association between cognitive fluctuations and activities of daily living and quality of life among institutionalized patients with dementia. Int J Geriatr Psychiatry 2018; 33:e280-e285. [PMID: 28940504 DOI: 10.1002/gps.4788] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 08/08/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Cognitive fluctuations (CFs) occur commonly in dementia of all types. While it is generally accepted that CFs can affect the clinical rating of dementia severity and neuropsychological performance, little is known about their impact on patients' activities of daily living (ADLs) and quality of life (QOL). Our study aims to explore the impact of CFs on ADLs and QOL among institutionalized patients with dementia. METHODS The present study examined the nature and frequency of CFs in 55 institutionalized dementia patients. We used the Dementia Cognitive Fluctuation Scale (DCFS) to assess the presence and severity of CFs. The Alzheimer's Disease Functional Assessment of Change Scale (ADFACS) was used to assess patients' ADLs, and the Quality of Life in Late Stage Dementia scale (QUALID) was used to assess QOL. Linear regression models were used to assess the relationships between CFs, ADLs, and QOL. RESULTS The mean age of the patients was 90.41 years (SD = 2.84). Their mean Aggressive Behavior Scale score was 1.13 (SD = 1.59), mean Severe Impairment Battery total score was 86.65 (SD = 13.77), and mean DCFS score was 10.07 (SD = 3.04). The mean ADFACS-ADL score was 10.88 (SD = 6.37), mean ADFACS-IADL score was 16.61 (SD = 9.54), and mean QUALID total score was 18.25 (SD = 5.70). DCFS significantly predicted ADFACS-ADL score (R2 = 0.39, β = 0.30, P = .011) although the relationship between ADFACS-IADL score and DCFS score was not significant (R2 = 0.16, P = .111). DCFS significantly predicted QUALID score (R2 = 0.08, β = 0.29, P = .033). CONCLUSION More severe CFs in patients with dementia were significantly associated with impaired ability to engage in ADLs and poorer QOL.
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Affiliation(s)
- Meng Sun
- Department of Psychiatry, The Second Xianga Hospital, Central South University; National Clinical Research Center on Mental Health Disorders (Xiangya); National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan; Key Laboratory of Psychiatry and Mental Health, Mental Health Institute of Central South University, China.,Division of Geriatric Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre; Department of Psychiatry, University of Toronto, Canada
| | | | | | - Sasha Mallya
- Department of Psychology, Ryerson University, Toronto, Canada
| | | | - Gwen Li Sin
- Department of Psychiatry, Singapore General Hospital, Singapore
| | - Kenneth I Shulman
- Division of Geriatric Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre; Department of Psychiatry, University of Toronto, Canada
| | - Nathan Herrmann
- Division of Geriatric Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre; Department of Psychiatry, University of Toronto, Canada
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Jellinger KA. Dementia with Lewy bodies and Parkinson's disease-dementia: current concepts and controversies. J Neural Transm (Vienna) 2017; 125:615-650. [PMID: 29222591 DOI: 10.1007/s00702-017-1821-9] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/28/2017] [Indexed: 12/15/2022]
Abstract
Dementia with Lewy bodies (DLB) and Parkinson's disease-dementia (PDD), although sharing many clinical, neurochemical and morphological features, according to DSM-5, are two entities of major neurocognitive disorders with Lewy bodies of unknown etiology. Despite considerable clinical overlap, their diagnosis is based on an arbitrary distinction between the time of onset of motor and cognitive symptoms: dementia often preceding parkinsonism in DLB and onset of cognitive impairment after onset of motor symptoms in PDD. Both are characterized morphologically by widespread cortical and subcortical α-synuclein/Lewy body plus β-amyloid and tau pathologies. Based on recent publications, including the fourth consensus report of the DLB Consortium, a critical overview is given. The clinical features of DLB and PDD include cognitive impairment, parkinsonism, visual hallucinations, and fluctuating attention. Intravitam PET and post-mortem studies revealed more pronounced cortical atrophy, elevated cortical and limbic Lewy pathologies (with APOE ε4), apart from higher prevalence of Alzheimer pathology in DLB than PDD. These changes may account for earlier onset and greater severity of cognitive defects in DLB, while multitracer PET studies showed no differences in cholinergic and dopaminergic deficits. DLB and PDD sharing genetic, neurochemical, and morphologic factors are likely to represent two subtypes of an α-synuclein-associated disease spectrum (Lewy body diseases), beginning with incidental Lewy body disease-PD-nondemented-PDD-DLB (no parkinsonism)-DLB with Alzheimer's disease (DLB-AD) at the most severe end, although DLB does not begin with PD/PDD and does not always progress to DLB-AD, while others consider them as the same disease. Both DLB and PDD show heterogeneous pathology and neurochemistry, suggesting that they share important common underlying molecular pathogenesis with AD and other proteinopathies. Cognitive impairment is not only induced by α-synuclein-caused neurodegeneration but by multiple regional pathological scores. Recent animal models and human post-mortem studies have provided important insights into the pathophysiology of DLB/PDD showing some differences, e.g., different spreading patterns of α-synuclein pathology, but the basic pathogenic mechanisms leading to the heterogeneity between both disorders deserve further elucidation. In view of the controversies about the nosology and pathogenesis of both syndromes, there remains a pressing need to differentiate them more clearly and to understand the processes leading these synucleinopathies to cause one disorder or the other. Clinical management of both disorders includes cholinesterase inhibitors, other pharmacologic and nonpharmacologic strategies, but these have only a mild symptomatic effect. Currently, no disease-modifying therapies are available.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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Delli Pizzi S, Bellomo RG, Carmignano SM, Ancona E, Franciotti R, Supplizi M, Barassi G, Onofrj M, Bonanni L, Saggini R. Rehabilitation program based on sensorimotor recovery improves the static and dynamic balance and modifies the basal ganglia neurochemistry: A pilot 1H-MRS study on Parkinson's disease patients. Medicine (Baltimore) 2017; 96:e8732. [PMID: 29390267 PMCID: PMC5815679 DOI: 10.1097/md.0000000000008732] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/13/2017] [Accepted: 10/26/2017] [Indexed: 02/06/2023] Open
Abstract
Rehabilitation interventions represent an alternative strategy to pharmacological treatment in order to slow or reverse some functional aspects of disability in Parkinson's disease (PD). To date, the neurophysiological mechanisms underlying rehabilitation-mediated improvement in PD patients are still poorly understood. Interestingly, growing evidence has highlighted a key role of the glutamate in neurogenesis and brain plasticity. The brain levels of glutamate, and of its precursor glutamine, can be detected in vivo and noninvasively as "Glx" by means of proton magnetic resonance spectroscopy (H-MRS). In the present pilot study, 7 PD patients with frequent falls and axial dystonia underwent 8-week rehabilitative protocol focused on sensorimotor improvement. Clinical evaluation and Glx quantification were performed before and after rehabilitation. The Glx assessment was focused on the basal ganglia in agreement with their key role in the motor functions. We found that the rehabilitation program improves the static and dynamic balance in PD patients, promoting a better global motor performance. Moreover, we observed that the levels of Glx within the left basal ganglia were higher after rehabilitation as compared with baseline. Thus, we posit that our sensorimotor rehabilitative protocol could stimulate the glutamate metabolism in basal ganglia and, in turn, neuroplasticity processes. We also hypothesize that these mechanisms could prepare the ground to restore the functional interaction among brain areas deputed to motor controls, which are affected in PD.
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Affiliation(s)
- Stefano Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara
| | - Rosa Grazia Bellomo
- Department of Medical Sciences, Oral and Biotechnology, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Simona Maria Carmignano
- Department of Medical Sciences, Oral and Biotechnology, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Emilio Ancona
- Department of Medical Sciences, Oral and Biotechnology, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Raffaella Franciotti
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara
| | - Marco Supplizi
- Department of Medical Sciences, Oral and Biotechnology, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Giovanni Barassi
- Department of Medical Sciences, Oral and Biotechnology, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara
| | - Raoul Saggini
- Department of Medical Sciences, Oral and Biotechnology, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
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Colloby SJ, Elder GJ, Rabee R, O'Brien JT, Taylor J. Structural grey matter changes in the substantia innominata in Alzheimer's disease and dementia with Lewy bodies: a DARTEL-VBM study. Int J Geriatr Psychiatry 2017; 32:615-623. [PMID: 27197956 PMCID: PMC5434823 DOI: 10.1002/gps.4500] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/19/2016] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Several cholinergic nuclei, and in particular the nucleus basalis of Meynert, are localised to the substantia innominata in the basal forebrain. These nuclei provide major cholinergic innervation to the cerebral cortex and hippocampus, and have an essential role in cognitive function. The aim of this study was to investigate volumetric grey matter (GM) changes in the substantia innominata from structural T1 images in Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and healthy older participants using voxel-based morphometry. METHODS Participants (41 DLB, 47 AD and 39 controls) underwent 3 T T1 magnetic resonance imaging and cognitive assessments. Voxel-based morphometry analysis used SPM8 with a substantia innominata brain mask to define the subspace for voxel GM analyses. Group differences, and selected behavioural and clinical correlates, were assessed. RESULTS Compared with that in controls, bilateral GM loss in the substantia innominata was apparent in both AD and DLB. Relative to controls, significant bilateral GM loss in the substantia innominata was observed in DLB and AD. In DLB, significant associations were also observed between substantia innominata GM volume loss, and the levels of cognitive impairment and severity of cognitive fluctuations. CONCLUSIONS Relative to that controls, atrophy of the substantia innominata was apparent in DLB and AD, and is associated with specific clinical manifestations in DLB. © 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Sean J. Colloby
- Institute of Neuroscience, Newcastle UniversityCampus for Ageing and VitalityNewcastle upon TyneUK
| | - Greg J. Elder
- Institute of Neuroscience, Newcastle UniversityCampus for Ageing and VitalityNewcastle upon TyneUK
| | - Riham Rabee
- Institute of Neuroscience, Newcastle UniversityCampus for Ageing and VitalityNewcastle upon TyneUK
| | - John T. O'Brien
- Institute of Neuroscience, Newcastle UniversityCampus for Ageing and VitalityNewcastle upon TyneUK,Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - John‐Paul Taylor
- Institute of Neuroscience, Newcastle UniversityCampus for Ageing and VitalityNewcastle upon TyneUK
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Onofrj M, Carrozzino D, D’Amico A, Di Giacomo R, Delli Pizzi S, Thomas A, Onofrj V, Taylor JP, Bonanni L. Psychosis in parkinsonism: an unorthodox approach. Neuropsychiatr Dis Treat 2017; 13:1313-1330. [PMID: 28553118 PMCID: PMC5439966 DOI: 10.2147/ndt.s116116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Psychosis in Parkinson's disease (PD) is currently considered as the occurrence of hallucinations and delusions. The historical meaning of the term psychosis was, however, broader, encompassing a disorganization of both consciousness and personality, including behavior abnormalities, such as impulsive overactivity and catatonia, in complete definitions by the International Classification of Diseases-10 (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Our review is aimed at reminding that complex psychotic symptoms, including impulsive overactivity and somatoform disorders (the last being a recent controversial entity in PD), were carefully described in postencephalitic parkinsonism (PEP), many decades before dopaminergic treatment era, and are now described in other parkinsonisms than PD. Eminent neuropsychiatrists of the past century speculated that studying psychosis in PEP might highlight its mechanisms in other conditions. Yet, functional assessments were unavailable at the time. Therefore, the second part of our article reviews the studies of neural correlates of psychosis in parkinsonisms, by taking into account both theories on the narrative functions of the default mode network (DMN) and hypotheses on DMN modulation.
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Affiliation(s)
- Marco Onofrj
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
| | - Danilo Carrozzino
- Department of Psychological, Health, and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Aurelio D’Amico
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
| | - Roberta Di Giacomo
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
| | - Stefano Delli Pizzi
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
| | - Astrid Thomas
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
| | - Valeria Onofrj
- Department of Bioimaging, University Cattolica del Sacro Cuore, Rome, Italy
| | - John-Paul Taylor
- Institute of Neuroscience, Campus for Ageing and Vitality Newcastle University Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Laura Bonanni
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
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