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Lumbar puncture safety and tolerability in premanifest and manifest Huntington's disease: a multi-analysis cross-sectional study. Sci Rep 2022; 12:18377. [PMID: 36319718 PMCID: PMC9626630 DOI: 10.1038/s41598-022-21934-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Lumbar puncture (LP) has become increasingly common for people with Huntington's disease (HD) both to administer intrathecal investigational medicinal products and to collect cerebrospinal fluid to develop biological markers to track disease stage and progression. We aimed to investigate the safety profile of LP in people with HD, building on a recently published work by increasing the sample size and more specifically, increasing the representation of the premanifest population and healthy controls. We conducted a multi-study cross-sectional analysis including eligible participants from the HDClarity (304 Huntington's disease gene expansion carriers and 91 controls) and HD-YAS studies (54 premanifest and 48 controls), enrolled between February 2016 and September 2019. We investigated the odds of any adverse events, headaches, and back pain independently. Intergroup comparisons and adjusted event odds were derived using hierarchical logistic regressions. A total of 669 LP procedures involving 497 participants were included in this analysis. There were 184 (27.5%) LP procedures associated with one or more adverse events. The two most common adverse events were: post LP headache and back pain. Younger age and female gender were found to be associated with a higher risk of developing adverse events. There was no difference in the rate of adverse events between the disease subgroups after adjusting for covariates such as age and gender. Our results suggest that the LP is safe and tolerable in premanifest and manifest HD subjects, providing useful reassurance about the procedure to the HD community.
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Rodrigues FB, Owen G, Sathe S, Pak E, Kaur D, Ehrhardt AG, Lifer S, Townhill J, Schubert K, Leavitt BR, Guttman M, Bang J, Lewerenz J, Levey J, Sampaio C, Wild EJ. Safety and Feasibility of Research Lumbar Puncture in Huntington's Disease: The HDClarity Cohort and Bioresource. J Huntingtons Dis 2022; 11:59-69. [PMID: 35253773 DOI: 10.3233/jhd-210508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Biomarkers are needed to monitor disease progression, target engagement and efficacy in Huntington's disease (HD). Cerebrospinal fluid (CSF) is an ideal medium to research such biomarkers due to its proximity to the brain. OBJECTIVE To investigate the safety and feasibility of research lumbar punctures (LP) in HD. METHODS HDClarity is an ongoing international biofluid collection initiative built on the Enroll-HD platform, where clinical assessments are recorded. It aims to recruit 1,200 participants. Biosamples are collected following an overnight fast: blood via venipuncture and CSF via LP. Participants are healthy controls and HD gene expansion carriers across the disease spectrum. We report on monitored data from February 2016 to September 2019. RESULTS Of 448 participants screened, 398 underwent at least 1 sampling visit, of which 98.24% were successful (i.e., CSF was collected), amounting to 10,610 mL of CSF and 8,200 mL of plasma. In the total 572 sampling visits, adverse events were reported in 24.13%, and headaches of any kind and post-LP headaches in 14.86% and 12.24%, respectively. Frequencies were less in manifest HD; gender, age, body mass index and disease burden score were not associated with the occurrence of the events in gene expansion carriers. Headaches and back pain were the most frequent adverse events. CONCLUSION HDClarity is the largest CSF collection initiative to support scientific research into HD and is now stablished as a leading resource for HD research. Our data confirm that research LP in HD are feasible and acceptable to the community, and have a manageable safety profile.
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Affiliation(s)
- Filipe B Rodrigues
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Gail Owen
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Swati Sathe
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | - Elena Pak
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | | | | | - Sherry Lifer
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
| | - Jenny Townhill
- Enroll-HD platform, European Huntington's Disease Network, University Hospital of Ulm, Ulm, Germany
| | - Katarzyna Schubert
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Blair R Leavitt
- Centre for Molecular Medicine and Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Mark Guttman
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jee Bang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jan Lewerenz
- Department of Neurology, Ulm University, Ulm, Germany
| | - Jamie Levey
- CHDI Management/CHDI Foundation, Princeton, NJ, USA.,Enroll-HD platform, European Huntington's Disease Network, University Hospital of Ulm, Ulm, Germany
| | | | | | - Edward J Wild
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, London, UK
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Hampel H, Shaw LM, Aisen P, Chen C, Lleó A, Iwatsubo T, Iwata A, Yamada M, Ikeuchi T, Jia J, Wang H, Teunissen CE, Peskind E, Blennow K, Cummings J, Vergallo A. State-of-the-art of lumbar puncture and its place in the journey of patients with Alzheimer's disease. Alzheimers Dement 2021; 18:159-177. [PMID: 34043269 PMCID: PMC8626532 DOI: 10.1002/alz.12372] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/24/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023]
Abstract
Recent advances in developing disease‐modifying therapies (DMT) for Alzheimer's disease (AD), and the recognition that AD pathophysiology emerges decades before clinical symptoms, necessitate a paradigm shift of health‐care systems toward biomarker‐guided early detection, diagnosis, and therapeutic decision‐making. Appropriate incorporation of cerebrospinal fluid biomarker analysis in clinical practice is an essential step toward system readiness for accommodating the demand of AD diagnosis and proper use of DMTs—once they become available. However, the use of lumbar puncture (LP) in individuals with suspected neurodegenerative diseases such as AD is inconsistent, and the perception of its utility and safety differs considerably among medical specialties as well as among regions and countries. This review describes the state‐of‐the‐art evidence concerning the safety profile of LP in older adults, discusses the risk factors for LP‐associated adverse events, and provides recommendations and an outlook for optimized use and global implementation of LP in individuals with suspected AD.
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Affiliation(s)
- Harald Hampel
- Eisai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
| | - Leslie M Shaw
- Perelman School of Medicine, Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Aisen
- USC Alzheimer's Therapeutic Research Institute, San Diego, California, USA
| | - Christopher Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alberto Lleó
- Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau-Biomedical Research Institute Sant Pau-Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Takeshi Iwatsubo
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsushi Iwata
- Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Masahito Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Asahimachi, Niigata, Japan
| | - Jianping Jia
- Innovation Center for Neurological Disorders, Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Elaine Peskind
- VA Northwest Mental Illness Research, Education and Clinical Center, VA Puget Sound Health Care System, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), Las Vegas, Nevada, USA
| | - Andrea Vergallo
- Eisai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
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4
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Abuyaman O, Combrinck M, Smith AD, Nexo E. The soluble transcobalamin receptor (sCD320) in relation to Alzheimer's disease and cognitive scores. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 77:332-337. [PMID: 28486088 DOI: 10.1080/00365513.2017.1323345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The soluble transcobalamin receptor (sCD320) is present in cerebrospinal fluid and correlates with the dementia-related biomarkers phospho-tau and total-tau. Here we present data on the relation of sCD320 to Alzheimer's disease and scores of cognitive tests. Lumbar cerebrospinal fluid samples from 42 pathologically-confirmed cases of Alzheimer's disease and 25 non-demented controls were analyzed for sCD320 employing an in-house ELISA. The participants' cognitive functions were tested using the Cambridge Cognition Examination (CAMCOG) and the Mini-Mental State Examination (MMSE). There was no significant difference in the median CSF sCD320 concentration between patients and controls. The median (2.5-97.5 percentiles) sCD320 for all participants (n = 67) was 15 (3-29) pmol/L. We observed a non-linear correlation between sCD320 and cognitive scores. Spearman's correlation between sCD320 and total CAMCOG scores was 0.627 (n = 16, p = .009) for CAMCOG scores ≤27, and -0.293 (n = 39, p = .071) for CAMCOG scores ≥68. Spearman's correlation between sCD320 and both the low (≤9) and high (≥16) total MMSE scores was 0.274, -0.363 (n = 18, 44), p = .272, .016, respectively. In conclusion, sCD320 cannot be employed as a biomarker for differentiating Alzheimer dementia patients from controls. Further studies are warranted to explore the non-linear correlations between sCD320 and scores of cognitive function.
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Affiliation(s)
- Omar Abuyaman
- a Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark.,b Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences , The Hashemite University , Zarqa , Jordan
| | - Marc Combrinck
- c Department of Medicine, Division of Geriatric Medicine , University of Cape Town, Observatory , Cape Town , South Africa
| | - A David Smith
- d Oxford Project to Investigate Memory and Ageing (OPTIMA) , University of Oxford, John Radcliffe Hospital , Oxford , UK.,e Department of Pharmacology , University of Oxford , Oxford , UK
| | - Ebba Nexo
- a Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark
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High Resolution Discovery Proteomics Reveals Candidate Disease Progression Markers of Alzheimer's Disease in Human Cerebrospinal Fluid. PLoS One 2015; 10:e0135365. [PMID: 26270474 PMCID: PMC4535975 DOI: 10.1371/journal.pone.0135365] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 07/21/2015] [Indexed: 11/21/2022] Open
Abstract
Disease modifying treatments for Alzheimer’s disease (AD) constitute a major goal in medicine. Current trends suggest that biomarkers reflective of AD neuropathology and modifiable by treatment would provide supportive evidence for disease modification. Nevertheless, a lack of quantitative tools to assess disease modifying treatment effects remains a major hurdle. Cerebrospinal fluid (CSF) biochemical markers such as total tau, p-tau and Ab42 are well established markers of AD; however, global quantitative biochemical changes in CSF in AD disease progression remain largely uncharacterized. Here we applied a high resolution open discovery platform, dMS, to profile a cross-sectional cohort of lumbar CSF from post-mortem diagnosed AD patients versus those from non-AD/non-demented (control) patients. Multiple markers were identified to be statistically significant in the cohort tested. We selected two markers SME-1 (p<0.0001) and SME-2 (p = 0.0004) for evaluation in a second independent longitudinal cohort of human CSF from post-mortem diagnosed AD patients and age-matched and case-matched control patients. In cohort-2, SME-1, identified as neuronal secretory protein VGF, and SME-2, identified as neuronal pentraxin receptor-1 (NPTXR), in AD were 21% (p = 0.039) and 17% (p = 0.026) lower, at baseline, respectively, than in controls. Linear mixed model analysis in the longitudinal cohort estimate a decrease in the levels of VGF and NPTXR at the rate of 10.9% and 6.9% per year in the AD patients, whereas both markers increased in controls. Because these markers are detected by mass spectrometry without the need for antibody reagents, targeted MS based assays provide a clear translation path for evaluating selected AD disease-progression markers with high analytical precision in the clinic.
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Djukic M, Schulz D, Schmidt H, Lange P, Nau R. Cerebrospinal fluid findings in geriatric patients from 2008 to 2011. Z Gerontol Geriatr 2014; 46:353-7. [PMID: 22903361 DOI: 10.1007/s00391-012-0380-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The chemical composition of the cerebrospinal fluid (CSF) is age-dependent. METHODS Routine CSF parameters, the indications for lumbar puncture (LP), and the most frequent complications were retrospectively studied in patients older (n = 167) and younger (n = 36) than 65 years. RESULTS In the absence of meningeal inflammation, the mean CSF lactate level of patients older than 65 years was slightly but significantly higher than the mean CSF lactate level of younger patients. The lactate level of patients with otherwise normal CSF findings correlated significantly with the age of the patients. In the absence of meningeal inflammation, the CSF-to-serum albumin ratio (QAlbumin) was significantly higher in older patients than in younger ones. The most frequent indication for LP, suspected infection of the central nervous system (CNS) (n = 110), was confirmed in 12.7% of patients. The only LP complication documented was headache in two patients. CONCLUSIONS Elevations of QAlbumin and CSF lactate levels appear to be nonspecific findings in elderly patients. Suspected infections, the most frequent indication for LP, were confirmed by CSF analysis in more than 10% of patients. The very low complication rate of LP makes it a very valuable tool in the diagnostic routine for older patients with CNS diseases.
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Affiliation(s)
- M Djukic
- Department of Neuropathology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
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7
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[Multicenter study on lumbar puncture indication, clinical practice and feasibility]. Rev Neurol (Paris) 2011; 168:28-32. [PMID: 22153704 DOI: 10.1016/j.neurol.2011.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 08/23/2011] [Accepted: 08/26/2011] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Cerebrospinal fluid (CSF) biomarkers have been extensively studied as diagnostic markers for Alzheimer's disease (AD). However, results are variable probably due to lumbar puncture (LP) procedure, CSF collection and transport. This intercenter variability highlights the need for an efficient standardization of clinical and technical procedures. The aims of this study were firstly to compare the LP procedure and CSF transport process in all French Memory Centers and secondly to evaluate the incidence of LP side effects in 100 patients with cognitive disturbances. METHODS LP practice and side effect prospective questionnaires were sent to all French Memory Centers in May 2010. Memory Centers were asked about their LP procedure. The prospective study over a three-week-period has evaluated the LP feasibility and side effects. All data were collected until the end of July 2010. RESULTS The answers of 18 out of 26 Memory Centers were collected. Although, these centers did not have the same LP procedure and CSF transport, the majority of them proceeded according to Innogenetics's advices concerning the use of polypropylene tubes and transport duration but not sample conditioning. Polypropylene tubes were different from one center to the other. CSF volume, pharmacological premedication and prevention of post-LP syndrome were variable in all responding centers. The prospective study carried out in 100 patients revealed a very good LP acceptability (93/100 patients). LP feasibility was 97 % (90/93) and failed LP were consequently performed with success using radiological scopes. Three minor complications were observed. DISCUSSION AND CONCLUSION All French Centers complied with Innogenetics' recommendations for pretechnical CSF procedures; however each Center put in place its own procedure that was different one center to the other. It will be very interesting to compare cut-off and result values for Aβ, tau and phosphorylated tau protein on threonine 181 between several centers that used their own procedures. Acceptability and safety were very good in our short but significant prospective study. These results confirm the data of Zetterberg et al., 2010.
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8
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Williams JH, Wilcock GK, Seeburger J, Dallob A, Laterza O, Potter W, Smith AD. Non-linear relationships of cerebrospinal fluid biomarker levels with cognitive function: an observational study. ALZHEIMERS RESEARCH & THERAPY 2011; 3:5. [PMID: 21329517 PMCID: PMC3109414 DOI: 10.1186/alzrt64] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 01/11/2011] [Accepted: 02/17/2011] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Levels of cerebrospinal fluid (CSF) β-amyloid (Aβ) and Tau proteins change in Alzheimer's disease (AD). We tested if the relationships of these biomarkers with cognitive impairment are linear or non-linear. METHODS We assessed cognitive function and assayed CSF Aβ and Tau biomarkers in 95 non-demented volunteers and 97 AD patients. We then tested non-linearities in their inter-relations. RESULTS CSF biomarkers related to cognitive function in the non-demented range of cognition, but these relations were weak or absent in the patient range; Aβ1-40's relationship was biphasic. CONCLUSIONS Major biomarker changes precede clinical AD and index cognitive impairment in AD poorly, if at all.
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Affiliation(s)
- Jonathan H Williams
- OPTIMA, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK.
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9
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Ohrfelt A, Andreasson U, Simon A, Zetterberg H, Edman A, Potter W, Holder D, Devanarayan V, Seeburger J, Smith AD, Blennow K, Wallin A. Screening for new biomarkers for subcortical vascular dementia and Alzheimer's disease. Dement Geriatr Cogn Dis Extra 2011; 1:31-42. [PMID: 22163231 PMCID: PMC3199889 DOI: 10.1159/000323417] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Novel biomarkers are important for identifying as well as differentiating subcortical vascular dementia (SVD) and Alzheimer's disease (AD) at an early stage in the disease process. Methods In two independent cohorts, a multiplex immunoassay was utilized to analyze 90 proteins in cerebrospinal fluid (CSF) samples from dementia patients and patients at risk of developing dementia (mild cognitive impairment). Results The levels of several CSF proteins were increased in SVD and its incipient state, and in moderate-to-severe AD compared with the control group. In contrast, some CSF proteins were altered in AD, but not in SVD. The levels of heart-type fatty acid binding protein (H-FABP) were consistently increased in all groups with dementia but only in some of their incipient states. Conclusions In summary, these results support the notion that SVD and AD are driven by different pathophysiological mechanisms reflected in the CSF protein profile and that H-FABP in CSF is a general marker of neurodegeneration.
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Affiliation(s)
- Annika Ohrfelt
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
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Liu PT, Dadu R, Sena K. LUMBAR PUNCTURE IN OLDER ADULTS: WHICH APPROACH IS SAFER? A RETROSPECTIVE COHORT STUDY. J Am Geriatr Soc 2010; 58:1617-8. [DOI: 10.1111/j.1532-5415.2010.02996.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yu SD, Chen MY, Johnson AJ. Factors associated with traumatic fluoroscopy-guided lumbar punctures: a retrospective review. AJNR Am J Neuroradiol 2009; 30:512-5. [PMID: 19147709 DOI: 10.3174/ajnr.a1420] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE To minimize diagnostic confusion, a CSF specimen should be free from traumatically introduced red blood cells (RBCs). The purpose of this research is to determine if patient age, sex, gauge of the lumbar puncture (LP) needle, or the level of LP is associated with an increased risk for traumatic fluoroscopy-guided LP. MATERIALS AND METHODS Data were collected retrospectively for consecutive male and female patients of all ages (n = 756) who underwent a fluoroscopy-guided LP for a 2-year period. We defined traumatic LP as a CSF sample with an RBC count more than 500 cells/mm(3) without xanthochromia. RESULTS Rate of traumatic LP was 13.3%. The rate of traumatic LP at the L4-L5 level (19%) was significantly higher than at the L2-L3 (9%) or L3-L4 level (10%). Patients older than 80 years had higher traumatic LP rates (25.9%) compared with patients between ages 11 and 80 years (12.4%). Sex and gauge of the spinal needle were not associated with increased rate of traumatic LP. Patients younger than 1 year had failed LP rate of 58.8% compared with 3.2% failure rate in older patients. CONCLUSIONS Fluoroscopy-guided LP at the L4-L5 level is associated with nearly twice the risk for traumatic puncture compared with the L2-L3 or L3-L4 level. Rates of traumatic result are twice as high in adults older than 80 years compared with younger patients. Failure rates for fluoroscopy-guided LP are low except in children younger than 1 year, in whom failure occurs in most cases.
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Affiliation(s)
- S D Yu
- Indiana University School of Medicine, Indianapolis, IN, USA.
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Lakhan SE, Kramer A. Schizophrenia genomics and proteomics: are we any closer to biomarker discovery? Behav Brain Funct 2009; 5:2. [PMID: 19128481 PMCID: PMC2627915 DOI: 10.1186/1744-9081-5-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Accepted: 01/07/2009] [Indexed: 12/13/2022] Open
Abstract
The field of proteomics has made leaps and bounds in the last 10 years particularly in the fields of oncology and cardiovascular medicine. In comparison, neuroproteomics is still playing catch up mainly due to the relative complexity of neurological disorders. Schizophrenia is one such disorder, believed to be the results of multiple factors both genetic and environmental. Affecting over 2 million people in the US alone, it has become a major clinical and public health concern worldwide. This paper gives an update of schizophrenia biomarker research as reviewed by Lakhan in 2006 and gives us a rundown of the progress made during the last two years. Several studies demonstrate the potential of cerebrospinal fluid as a source of neuro-specific biomarkers. Genetic association studies are making headway in identifying candidate genes for schizophrenia. In addition, metabonomics, bioinformatics, and neuroimaging techniques are aiming to complete the picture by filling in knowledge gaps. International cooperation in the form of genomics and protein databases and brain banks is facilitating research efforts. While none of the recent developments described here in qualifies as biomarker discovery, many are likely to be stepping stones towards that goal.
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Affiliation(s)
- Shaheen E Lakhan
- Global Neuroscience Initiative Foundation, Los Angeles, CA, USA.
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Wu G, Sankaranarayanan S, Tugusheva K, Kahana J, Seabrook G, Shi XP, King E, Devanarayan V, Cook JJ, Simon AJ. Decrease in age-adjusted cerebrospinal fluid β-secretase activity in Alzheimer's subjects. Clin Biochem 2008; 41:986-96. [DOI: 10.1016/j.clinbiochem.2008.04.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 03/12/2008] [Accepted: 04/20/2008] [Indexed: 12/30/2022]
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Popp J, Riad M, Freymann K, Jessen F. [Diagnostic lumbar puncture performed in the outpatient setting of a memory clinic. Frequency and risk factors of post-lumbar puncture headache]. DER NERVENARZT 2007; 78:547-51. [PMID: 17160541 DOI: 10.1007/s00115-006-2174-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lumbar puncture (LP) is growing in relevance for the diagnosis of cognitive impairment in the elderly. Due to the expected risk of post-lumbar puncture syndrome or other complications LPs have rarely been performed in the outpatient setting. Using a questionnaire, the post-lumbar puncture symptoms of 100 patients (54-84 years old; mean: 68.87 years; SD: 7.9) have been prospectively gathered after consecutively performed LPs in the Memory Clinic of the Department of Psychiatry, University of Bonn. Some of these patients were included in the early diagnosis program of the German Dementia Competence Network. Of the patients 9% developed a post-lumbar puncture syndrome of mild or middle intensity. The influence of gender, age, cognitive status, as well as a supplementary diagnosis of depression and needle size (G20 or G22 atraumatic Sprotte needle) on the incidence of the post-LP syndrome was evaluated by means of logistic regression. Only the patients' age was identified as a significant risk factor as with increasing age a diminishing risk of developing a post-lumbar puncture syndrome was found (OR=0.83; CI=0.71-0.97 per year). None of the other factors evaluated proved to be of significant influence. The post-LP symptoms did not necessitate supplementary consultations in any of the cases.
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Affiliation(s)
- J Popp
- Diagnostik- und Behandlungszentrum für Gedächtniserkrankungen im Alter, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Rheinische-Friedrich-Wilhelms-Universität, Sigmund-Freud-Str. 25, 53105, Bonn.
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15
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Scherder EJA, Slaets J, Deijen JB, Gorter Y, Ooms ME, Ribbe M, Vuijk PJ, Feldt K, van de Valk M, Bouma A, Sergeant JA. Pain assessment in patients with possible vascular dementia. Psychiatry 2003; 66:133-45. [PMID: 12868293 DOI: 10.1521/psyc.66.2.133.20618] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PREVIOUS studies comparing Alzheimer's disease (AD) patients with the normal elderly suggest that AD patients experience less pain. In the present study, pain reporting in 20 patients with possible vascular dementia (VaD) was compared to 20 nondemented elderly who had comparable pain conditions. It was hypothesized that, due to de-afferentiation, the possible VaD patients would experience more pain than the cognitively intact elderly. Pain assessment was conducted using three visual analogue scales, (1) the Coloured Analogue Scale (CAS) for Pain Intensity, (2) the CAS for Pain Affect, and (3) the Faces Pain Scale (FPS); a verbal pain questionnaire, Number of Words Chosen--Affective (NWC-A) of the McGill Pain Questionnaire; and an observation scale, the Checklist of Nonverbal Pain Indicators (CNPI). Results showed a significant increase in the scores on the CAS for Pain Affect and the FPS in the demented patients compared to the control group. There was a tendency for an increase in scores on the CNPI in the VaD group. These results suggest that patients with possible VaD suffer more pain than healthy elderly without cognitive impairment.
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Affiliation(s)
- Erik J A Scherder
- Department of Clinical Neuropsychology, Vrije Universiteit, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
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16
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Abstract
This article reviews historical aspects and the following complications of lumbar puncture: cerebral and spinal herniation, postdural puncture headache, cranial neuropathies, nerve root irritation, low back pain, stylet associated problems, infections, and bleeding complications. The incidence of postdural puncture headache can be greatly reduced by pointing the face of the bevel in the direction of the patient's side, replacing the stylet and rotating the needle 90;dg before withdrawing the needle, and using the Sprotte atraumatic needle, especially in high risk patients.
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Affiliation(s)
- R W Evans
- Department of Neurology, University of Texas at Houston Medical School, Houston, Texas, USA
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